National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
Our extensive experience over more than three decades has provided significant insight into the evolving experiences of people with disability and their families within service systems and the broader community. Most importantly, it has given us the privilege of learning directly from people with disability and their families about what truly matters in their lives, what enables meaningful participation, and what barriers continue to impact equity, inclusion and wellbeing.
It is on this basis and informed by both longstanding clinical experience and the lived experiences of the individuals and families we support, that the following concerns are raised regarding the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.
Concerns Regarding the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026
acknowledges the importance of ensuring the long-term sustainability, integrity and effectiveness of the National Disability Insurance Scheme (NDIS). However, based on our extensive clinical experience working alongside people with disability and their families, we hold significant concerns regarding aspects of the proposed legislation and the potential unintended consequences for some of the most vulnerable members of our community. The concerns outlined below are informed not only by professional knowledge and evidence-informed practice, but by decades of direct experience supporting children, adults, families and carers navigating the realities of disability within everyday life.
• Defining Functional Capacity
The Bill proposes a new definition of “functional capacity” requiring assessment of what a person can do: • without assistance from others, • without assistive technology or modifications, and • excluding environmental and personal circumstances as far as possible. This represents a significant shift in how disability and functional capacity are conceptualised. As Occupational Therapists, our practice is founded on the understanding that function cannot be separated from context. A person’s ability to participate safely and meaningfully in daily life is profoundly influenced by their environment, supports, relationships, routines, assistive technology and the demands placed upon them. Many people function as well as they do precisely because appropriate supports and adaptations are already in place. Removing these factors from consideration risks creating an artificial and incomplete picture of disability that does not reflect the realities of everyday life. In practice, many of the participants we support may appear highly capable within a structured or familiar assessment environment, particularly for a short period of time. However, this observed performance often does not reflect the substantial support, prompting, preparation, supervision, co- regulation and environmental modification occurring behind the scenes to make that level of functioning possible. This concern is particularly relevant for people with: • autism and masking presentations,
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• psychosocial disability, • fluctuating conditions, • intellectual disability, • executive functioning difficulties, • invisible disabilities, • sensory regulation difficulties, and • chronic fatigue or burnout associated with participation demands. As Occupational Therapists, we assess far more than isolated task performance. We assess: • safety, • sustainability of function over time, • behavioural and emotional regulation, • fatigue, • environmental barriers, • participation across settings, • and the level of support required for a person to function consistently and safely within their real- world environments. Many participants function because: • parents or carers provide constant prompting and supervision, • support workers assist with daily routines, • environments have already been modified, • assistive technology compensates for limitations, • and families structure their entire lives around maintaining regulation and safety. If these realities are intentionally excluded from assessment processes, there is a significant risk that participants’ actual disability-related support needs will be underestimated.
For example, we support a young person with autism who presents as articulate, socially engaging and highly capable during appointments. However, without extensive preparation, prompting and supervision from his parents, he is unable to independently manage basic self-care tasks safely or navigate the community due to significant deficits in safety awareness and executive functioning. We also support participants who can engage successfully in therapy sessions or community activities for short periods, but who require substantial recovery time afterwards due to sensory overload, emotional dysregulation or exhaustion. In some cases, families must provide intensive co-regulation, modify routines and reduce demands significantly in order to prevent severe distress or behavioural escalation that may place both the participant and family members at risk. These experiences are not isolated. They reflect the lived realities of many people with disability whose support needs may not be immediately visible within standardised or time-limited assessments.
We strongly believe that disability cannot be meaningfully separated from environment, context and supports. Functional capacity assessments must therefore consider: • environmental context, • assistive technology, • informal and family supports, • behavioural regulation, • fatigue and recovery, • sustainability of participation,
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• and functioning across multiple real-world environments over time. Assessments should be undertaken by appropriately qualified allied health professionals with expertise in functional assessment and disability. Assessment processes must also explicitly recognise fluctuating conditions, invisible disabilities and masking presentations. Most importantly, assessments must consider not only what a person can do in a brief or supported moment, but whether that level of functioning is safe, sustainable and realistically maintainable within everyday life.
As Occupational Therapists, we are deeply concerned that the proposed definition of functional capacity risks disadvantaging people whose disabilities are complex, fluctuating, invisible or heavily influenced by environmental demands and support availability.
• Tightening the Definition of “Permanent” Disability
The Bill proposes that impairments may not be considered permanent unless: • all “appropriate treatment” has been undertaken, and • further treatment is unlikely to materially improve the impairment. The legislation further suggests that treatment may still be considered “appropriate” even where a participant cannot realistically access it due to financial circumstances or geographic location. This raises significant concerns. The term “appropriate treatment” remains insufficiently defined and there appears to be no clear limit regarding what interventions participants may be expected to pursue before their disability is recognised as permanent. In practice, many people with lifelong disability continue to engage in therapy, rehabilitation, behavioural intervention, psychology, medication management and allied health supports throughout their lives. These interventions are not undertaken because their disability is temporary or expected to resolve. Rather, they are necessary to: • maintain function, • reduce decline, • support participation, • improve safety, • manage distress, • and maximise quality of life. Ongoing treatment does not mean a disability is temporary.
Many of the participants we support with autism, intellectual disability, psychosocial disability and degenerative neurological conditions will require ongoing support across their lifespan. Some conditions fluctuate significantly over time, while others progressively worsen with age. We are particularly concerned about the impact of these provisions on participants experiencing socioeconomic disadvantage.
Many families we support are already living under significant financial strain. Some are forced to choose between essential living expenses and accessing therapy, medication or specialist care. Others cannot afford fuel to attend appointments, cannot take time away from work to support their child’s therapy participation, or face long public waitlists with limited local services available.
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
For some participants, treatment may technically exist but is not realistically accessible. We also support individuals with degenerative and life-limiting conditions for whom recovery is not possible. In these situations, therapeutic intervention focuses on maintaining function, preserving dignity, maximising comfort and supporting quality of life for as long as possible.
It is essential that the legislation recognises the diversity and complexity of disability experiences and clarifies the definition of “appropriate treatment” accordingly. Participants should not be disadvantaged due to: • financial hardship, • geographic isolation, • lack of service availability, • inability to access specialists, • or significant side effects or limitations associated with treatment options. Expectations regarding treatment must remain realistic, evidence-based and genuinely accessible. We are deeply concerned that requiring participants to demonstrate they have exhausted all possible treatment options before their disability is recognised as permanent may create further inequity and place unreasonable burdens on individuals and families already experiencing significant disadvantage and stress.
• Supports Must Arise “Directly” From Impairment
The Bill proposes that supports must arise “directly” from impairment, with the explanatory memorandum describing this as the “direct and immediate source, cause or origin” of the support need. We are concerned this wording significantly narrows the understanding of disability and disability- related support needs. In clinical practice, support needs rarely arise from impairment alone. Rather, they emerge through the interaction between: • impairment, • environmental demands, • sensory and social environments, • fatigue, • housing circumstances, • behavioural regulation, • community accessibility, • support availability, • and participation barriers. Many participants function safely only because extensive environmental modifications, assistive technology, support workers, family supervision or structured routines are already in place. Attempting to isolate impairment from the environments in which people live risks oversimplifying disability and overlooking the complex realities that contribute to participation restrictions and support needs. For example, participants may require supports because: • inaccessible housing creates safety risks, • sensory environments trigger dysregulation, • community settings are not inclusive,
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• or the absence of support increases vulnerability to crisis, isolation or harm. These needs are still fundamentally disability-related. The legislation must continue to recognise the interaction between: • impairment, • environment, • participation barriers, • and support needs. It should remain aligned with: • the social model of disability, • principles of occupational participation, • contemporary disability practice, • and person-centred, rights-based approaches. It is also critical that supports aimed at preventing: • crisis, • safeguarding risks, • social isolation, • carer breakdown, • and unsafe living situations continue to be recognised as legitimate disability-related supports. As Occupational Therapists, we are concerned that narrowing the interpretation of disability-related need may reduce recognition of the real-world circumstances in which disability occurs and may unintentionally disadvantage people whose support needs are shaped by the interaction between impairment and environment, rather than impairment alone. Many of our participants will be significantly adversely impacted by this change and their risk of increased social isolation is beyond belief. Our participants and their families already struggle with inclusion and participation across environments and the increased risks are HIGHLY significant. We spend a significant amount of time supporting carers who are at high risk of breakdown and parents who are unwell and ageing but are required to sustain an unrealistic workload of support and care for their person with a disability and are desperate to plan for the future when they are no longer able to provide supports. Many of our parents are also supporting multiple children with significant disabilities and highly diverse needs. All of this while they are working to provide housing and basic essential needs such as food.
• Changes to “Value for Money
The proposed changes to “Value for Money” are deeply concerning, as they strengthen the NDIA’s ability to prioritise lower-cost “comparable supports” when determining reasonable and necessary funding. This appears to reduce emphasis on whether supports achieve equivalent functional, safety and participation outcomes for participants.
There is significant concern that cost may increasingly become the dominant consideration, even where lower-cost alternatives result in poorer outcomes, reduced independence, increased risk, and greater long- term expense. Participants may be expected to accept “good enough” supports rather than supports that maximise safety, participation, dignity and sustainable long-term outcomes.
Occupational therapy recommendations are grounded in clinical evidence and focus on:
• safety
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• independence
• sustainability
• prevention
• participation
• long-term functional outcomes.
For participants with complex physical, postural and intellectual disabilities, lower-cost alternatives are often not truly comparable. For example, a basic wheeled shower commode may initially appear more cost effective; however, without essential features such as tilt-in-space positioning, lateral and hip supports, and pressure care components, the participant may be placed at significant risk of sliding, falls, injury and pressure wounds.
We regularly support participants who require:
• complex wheelchairs where basic alternatives compromise safety and function
• appropriate therapy intensity to maintain capacity and prevent decline
• adequate staffing supports to ensure safe care
• comprehensive home modifications rather than partial solutions
• meaningful community participation supports
• timely and appropriate assistive technology.
While lower upfront costs may appear financially attractive, inadequate or inappropriate supports frequently result in increased long-term expenditure through equipment failure, replacement costs, injury, hospitalisation, carer fatigue and loss of function. Most importantly, participant safety and dignity must remain paramount. People with disability are valued members of our community and are entitled to supports that enable independence, participation and quality of life.
Any legislation relating to “comparable supports” must require that alternative supports provide:
• equivalent safety
• equivalent functional benefit
• sustainability
• meaningful participation outcomes.
Decision-making must also consider:
• long-term costs
• prevention of functional decline
• carer burden
• safeguarding risks
• sustainability of supports and care arrangements,
rather than focusing solely on upfront expenditure.
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
Participants should never be forced to accept supports that are unsafe, ineffective, inappropriate or unsustainable. Value for money considerations must include quality of life, dignity, independence and long- term participation outcomes — not cost alone.
• “Effective and Beneficial” Evidence Hierarchy
The proposed hierarchy of evidence is concerning as it places significant emphasis on published peer- reviewed research over participant-specific clinical reasoning, lived experience and functional assessment. While research evidence is important, many people with disability have highly individualised, complex or rare presentations that do not fit neatly within standardised research populations.
Disability supports are not one-size-fits-all. Occupational therapy practice relies on integrating available evidence with clinical expertise, functional assessment and the lived experience of participants and families to determine the most appropriate and effective supports. There is concern that an overreliance on published evidence may become a mechanism to deny innovative or individualised supports, particularly where large-scale research does not exist.
This may disproportionately disadvantage participants with:
• rare or degenerative conditions
• psychosocial disability
• autism and neurodivergent presentations
• fluctuating conditions
• highly individualised assistive technology and support needs.
Importantly, many supports are essential not because they produce measurable “improvement,” but because they maintain function, prevent decline, reduce risk and preserve quality of life. Standardised research frameworks cannot fully capture the complexity, variability and real-world participation needs of many participants.
Any evidence framework within the Bill must provide strong weighting to:
• participant-specific evidence
• clinical reasoning
• lived experience
• functional assessment
• individual variability and complexity.
Legislation must remain flexible enough to ensure participants are not disadvantaged simply because their needs are uncommon, complex or difficult to measure within traditional research models.
We are highly concerned that the proposed hierarchy of evidence may reduce the weighting given to participant-specific clinical reasoning and lived experience. Many participants have highly individualised support needs that do not fit neatly into published research evidence. This may disproportionately disadvantage people with rare conditions, psychosocial disability or complex presentations. As occupational therapists we see this daily with our participants and we aim to utilise all available evidence in conjunction with clinical reasoning and our understanding of the participants individualised and specific needs to ensure intervention and support is the best and most appropriate available.
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• Increased Reliance on Informal Supports and Parents
The proposed strengthening of the presumption that parents are responsible for supervision, personal care, behavioural support, emotional support, transport and daily assistance is deeply concerning. While these supports may be described as tasks “ordinarily expected” of parents of children of a similar age, the legislation appears to focus on the type of support provided without adequately recognising the intensity, frequency, complexity, duration and specialised nature of disability-related care. Parents of children with disability are often undertaking the same categories of parenting tasks as other families, but at vastly greater levels of demand, vigilance and risk. This may include: • constant 1:1 supervision to maintain safety • managing absconding or self-harm risks • overnight seizure monitoring or respiratory monitoring • prolonged behavioural co-regulation • physical assistance with all transfers and personal care • responding to severe behavioural escalation or sensory dysregulation • disrupted sleep for extended periods to ensure the safety of their child. Many of the families we support provide extraordinary levels of care that extend well beyond ordinary parenting expectations, often at significant physical, emotional, psychological and financial cost. We regularly work with parents who experience chronic sleep deprivation, injury, declining health, workforce withdrawal and emotional exhaustion due to the sustained and intensive support needs of their child or family member with disability.
Some families provide 24-hour active supervision because the consequences of inadequate support are life-threatening. Others manage significant behaviours of concern that place parents, siblings and other family members at ongoing risk of harm. These demands frequently impact the wellbeing of the entire household, including siblings and extended family members, and become increasingly unsustainable as parents age and participants grow physically larger and more complex to support. Occupational therapists routinely assess caregiver burden, family sustainability, behavioural support needs, sleep disruption, manual handling risks and the broader impact of disability-related care demands on family functioning. Reframing these highly specialised and intensive supports as “ordinary parenting” risks minimising the realities faced by families and may result in reduced access to essential supports until families reach crisis point. This may disproportionately affect families supporting children and adults with: • autism • intellectual disability • psychosocial disability • complex behavioural support needs • epilepsy and high medical needs • significant physical disability and mobility limitations. Carer burnout, emotional exhaustion and family breakdown are real and increasingly common risks within the disability sector. Reliance on informal care arrangements without adequate recognition and support is neither sustainable nor safe. It is essential that the Bill clearly distinguishes between ordinary parenting responsibilities and disability- related care that is intensive, complex and lifelong in nature. Decision-making must appropriately consider caregiver burden, sleep disruption, behavioural complexity, workforce participation impacts, family wellbeing, safeguarding risks and the long-term sustainability of informal care arrangements.
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• Change to Whole of Person Assessment
The Bill appears to narrow decision-making away from a whole-of-person understanding of disability and toward support needs that can be directly attributed to a recognised impairment. This is concerning because people are not defined by a single diagnosis or impairment. Many participants experience multiple and intersecting factors that collectively impact their functioning and support needs, including:
• multiple impairments and comorbidities
• fatigue and chronic health issues
• sensory processing differences
• psychosocial factors and trauma histories
• communication and cognitive challenges
• environmental and participation barriers
• limited informal supports.
Occupational therapists assess people holistically, recognising that support needs often arise from the interaction between impairments, environments and daily life demands. Functional capacity cannot always be separated into isolated diagnostic categories.
For example, many participants may function safely within their home environment with trusted carers but are unable to manage unfamiliar environments, community settings or new support workers due to cognitive, sensory, behavioural or psychosocial factors. Other participants with intellectual disability and psychosocial disability require ongoing support to make safe decisions, participate meaningfully in daily life and maintain their wellbeing both at home and in the community.
If support needs must be narrowly attributed to a single recognised impairment, participants with complex, cumulative or intersecting disabilities may be unfairly disadvantaged and excluded from necessary supports. This creates significant risk for people whose needs do not fit neatly within rigid diagnostic boundaries.
Legislation must preserve a whole-of-person approach to assessment and funding decisions. Supports should be recognised where needs arise from the interaction between impairments, environmental barriers and participation limitations, rather than requiring overly narrow attribution to one condition alone. Assessment frameworks must remain flexible enough to recognise the complexity and lived reality of disability.
• Controlling Scheme and Plan Inflation
The Bill significantly restricts unscheduled reassessments by extending decision-making timeframes from 21 days to 90 days, limiting who can request reassessment, increasing evidentiary requirements, and narrowing the definition of exceptional circumstances. This is highly concerning, as many participants require reassessment due to urgent and complex changes in circumstances, including: • carer breakdown • hospital admission or discharge • behavioural escalation
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
• housing instability • equipment failure • increasing safety risks • functional deterioration • crisis within the family or support environment. Moving from a potential three-week response timeframe to up to three months may leave participants without appropriate supports during periods of significant vulnerability. In practice, support needs do not always deteriorate suddenly or neatly. Gradual decline, cumulative stress and increasing risk can still result in serious consequences for participants and families if supports are not adjusted in a timely manner. Occupational therapists frequently identify escalating risks before participants or families reach crisis point. Reassessment requests are often made because informal supports are becoming unsustainable, carers are experiencing burnout, behaviours are increasing, environments are no longer safe, or existing equipment and supports are no longer appropriate. There is significant concern that participants may need to become more unsafe, more unwell or more functionally impaired before reassessment is approved. Delays in reassessment may increase the risk of: • hospitalisation • safeguarding concerns • homelessness or housing breakdown • family breakdown • crisis-driven intervention • avoidable decline in health and function. There is also concern that participants without access to strong allied health support, advocacy or financial resources may struggle to meet stricter evidence requirements, further disadvantaging vulnerable individuals and families. It is essential that the Bill retain responsive reassessment pathways, particularly where safety, safeguarding or crisis issues are present. Clear urgent reassessment processes should exist for situations involving hospital discharge, carer breakdown, behavioural escalation, housing instability and significant functional decline. Assessment frameworks must also recognise gradual, cumulative and fluctuating changes in function, while ensuring evidence requirements remain realistic and accessible.
Summary The National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 represents a significant shift in the legal and philosophical foundations of the NDIS. While presented as a sustainability reform, the cumulative effect of the proposed amendments risks fundamentally altering the principles of participant choice and control, weakening individualised planning, narrowing access pathways and embedding increasingly standardised and fiscally driven approaches to disability support.
National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 Submission 2281
Of particular concern are the repeal of section 31, the expansion of Ministerial powers relating to funding decisions, the tightening of permanence requirements and the broad authorisation of automated decision-making. Collectively, these changes signal a movement away from the original intent of the Scheme and risk oversimplifying disability, narrowing interpretations of support need, reducing flexibility and diminishing recognition of the real-world complexity experienced by people with disability and their families. As occupational therapists, we are deeply concerned that these reforms may disproportionately impact people with invisible, fluctuating and complex disabilities, while simultaneously increasing reliance on unpaid carers and crisis-based systems. This is likely to occur in the context of reduced access to occupational therapy and other capacity-building supports that are essential for maintaining function, participation, safety and long-term wellbeing. Throughout consultation and sector discussions, participants and families consistently described feeling unheard, frightened, exhausted and deeply worried about the future of disability support in Australia. A recurring concern was that poorly supported disability does not disappear. Instead, unmet support needs often re-emerge through: • hospital admissions • family breakdown • homelessness • safeguarding concerns • mental health deterioration • school disengagement • carer burnout • crisis-driven intervention • and increased long-term system costs. Sustainability cannot be measured solely through reductions in Scheme expenditure. A genuinely sustainable NDIS must also protect dignity, participation, safety, family stability, human rights and equitable access to support. It is essential that the Bill preserves a whole-of-person approach to disability and recognises that support needs arise through the interaction of impairments, environmental barriers, psychosocial factors and participation demands. People with disability must not be reduced to diagnostic categories, standardised funding models or narrowly interpreted impairments. We therefore strongly urge the Committee to substantially amend the Bill, retain core participant protections, strengthen safeguards and delay implementation until meaningful consultation, impact assessment and foundational support systems are properly established. The NDIS was created because Australians recognised that people with disability deserve dignity, autonomy, inclusion and equality. Any reform to the Scheme must strengthen these principles, not diminish them. The people we support need to be recognised, valued and supported.
Yours Sincerely