Vision 2020

Submission 2504

`

Submission to the Community

Affairs Legislation Committee

Bill 2026

July 2026

National body working in partnership to prevent avoidable blindness and improve vision care

Submission 2504

Contents

Introduction 2

Summary of Recommendations 2 Recommendation 1: Key Principles 3

The Need for Cautious Implementation` 4

Recommendations 2 and 3: Support Determinations 5 Recommendations 4 and 5: Social and Community Participation Supports 6 Recommendations 6 and 7: Assessment of Permanence and

Appropriate Treatments 7

Recommendation 8: Definition of Functional Capacity` 8

Recommendation 9: Retaining Streamlined Access Pathways 8

Recommendation 10: Plan Suspensions and Accessible

Communication 9 Recommendation 11: Alternative Systems of Support 10 Recommendation 12: Consultation and Implementation 11 About Vision 2020 12

Submission 2504

Introduction

Vision 2020 welcomes the opportunity to provide this submission to the Senate Community Affairs Legislation Committee.

`As the national peak body for the eye health and vision care sector, we represent organisations working across prevention, treatment, rehabilitation, low vision services, consumer advocacy and community support. Our members are committed to ensuring that Australians who are blind or have low vision can participate fully in community life, maintain their independence and exercise choice and control over the supports they receive.

Our members support efforts to improve the long-term sustainability of the National Disability Insurance Scheme (NDIS). However, reforms must not undermine the Scheme’s ability to meet the reasonable and necessary support needs of people who are blind or have low vision. Any changes to the Scheme must preserve participant independence, recognise the disabling impact of inaccessible environments, and ensure that reforms are developed and implemented in partnership with people with disability.

This brief submission complements and endorses the views of our members offered in their own submissions and discusses amendments and other developments since the initial consultation period.

Summary of Recommendations

Recommendation 1

Section 31 of the NDIS Act, which requires consideration of a participant’s individual circumstances when developing plans, should not be repealed as proposed. The Government should seek to uphold the choice and control which is a fundamental feature of the scheme. Recommendation 2 `Support determinations should not apply to Improved Daily Living Skills supports, recognising that blindness and low vision are lifelong conditions and that capacity-building supports such as orientation and mobility training, assistive technology training and low vision rehabilitation are often required at multiple points throughout a person’s life.

Recommendation 3 Before any support determination is made, the legislation should require the Minister to commission and publish disability-specific impact analysis examining the effects of the determination on affected disability cohorts.

Recommendation 4 The proposed protections for Social and Community Participation funding should ensure participants can continue to access supports required for health care, medical appointments, employment, essential daily activities and community participation.

Recommendation 5 The Government should ensure that changes to Social and Community Participation funding are easy to understand and operationalise, including consideration of dedicated line items where necessary, and clarity for participants and providers about how much funding is included in a plan.

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Recommendation 6 People with disability should only be expected to have exhausted treatments which are genuinely available through Medicare, the Pharmaceutical Benefits Scheme or the public health system before applying for NDIS access.

Recommendation 7 Where a suitably qualified ophthalmologist certifies that all clinically appropriate treatment options have been exhausted, that clinical assessment should be accepted for the purposes of NDIS access, and NDIA staff should not override specialist medical advice.

Recommendation 8

The definition of functional capacity proposed in the bill should not be included. Government should work with the disability sector to trial assessments based on this definition before it is introduced into law.

Recommendation 9 The Bill should preserve a streamlined NDIS access pathway for people who are legally blind or who have permanent bilateral vision loss. If existing diagnosis-based access arrangements are amended or replaced, equivalent streamlined mechanisms should be maintained for conditions where substantial and enduring disability-related support needs are well established.

Recommendation 10 The legislation should specify that reasonable attempts to contact a participant must:

• use the participant’s recorded preferred communication format;

• involve multiple contact attempts and methods where appropriate;

• consider whether accessibility barriers are preventing engagement;

• consider whether the participant is awaiting assistive technology, training or other supports necessary to access information; and

• involve nominees, authorised representatives, support coordinators or other approved contacts where appropriate before a plan is suspended. Recommendation 11 Participants who are blind or have low vision should not be excluded from the NDIS unless governments can demonstrate that alternative systems of support will provide accessible, timely, appropriate and genuinely equivalent supports.

Recommendation 12 The Government should ensure that people with disability and representative organisations are meaningfully involved in the design and implementation of NDIS reforms.

Recommendation 1: Key Principles

Our members believe reforms to the NDIS should be guided by several fundamental principles:

supports should be based on individual need and functional impact; people with disability should maintain genuine choice and control;

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reforms should be co-designed with people with disability and representative organisations; changes should not transfer unmet support needs onto families, carers or inaccessible mainstream systems; and people who are blind or have low vision should not be disadvantaged because their support needs arise from environmental barriers rather than physical assistance with daily living activities. In our view, these principles are not merely desirable features of good policy. They reflect core elements of the original vision of the NDIS as an individualised, rights-based system of support.

The Bill, as introduced, represents a significant departure from these foundational principles. While framed as a package of administrative and sustainability measures, many of the Bill’s provisions would move decision-making away from consideration of an individual’s circumstances and towards decisions that apply to broad groups of participants. Taken together, the proposed reforms risk fundamentally altering the philosophical foundations of the Scheme.

A system that increasingly relies on broad assumptions about categories of support or groups of participants is less capable of recognising the diversity of participant needs and circumstances, and less capable of delivering genuine choice and control.

Our members are particularly concerned about the proposed repeal of section 31 of the Act. Section 31 currently establishes the principle that participant plans are built around an individual’s circumstances, goals and support needs. Its repeal would remove a key legislative safeguard underpinning the individualised nature of the Scheme and replace it with a framework that increasingly enables decisions to be made at a group or system level rather than through assessment of individual need. As several disability organisations have argued, this represents a profound change in the character of the NDIS itself.

The cumulative effect of the Bill’s provisions—including powers to reduce funding for categories of supports, narrow definitions of functional capacity, constrain access to reviews and make broad determinations affecting groups of participants—suggests a model that is less centred on the individual and more focused on managing cohorts of participants through standardised mechanisms. For our members, this is inconsistent with the core purpose of the NDIS.

Vision 2020 therefore considers that the Bill, in its current form, should not proceed. The Government should return to these fundamental principles as the basis for future reform and work in genuine partnership with people with disability and their representative organisations to design changes that strengthen the sustainability of the Scheme without undermining its foundational commitment to individualised support, choice and control.

The remainder of this submission explains how specific provisions of the Bill fail to meet each of these principles and identifies reforms necessary to restore them.

The Need for Cautious Implementation

The experience of people who are blind or have low vision illustrates the importance of caution and consultation when introducing reform at this scale. Reforms that appear to

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apply uniformly across the Scheme can have markedly different effects on particular disability cohorts because supports are used in different ways by different groups.

Recent proposals relating to Social and Community Participation supports provide a clear example. While these supports may sometimes be characterised as discretionary recreational supports, people who are blind or have low vision often rely upon them to undertake essential activities such as attending medical appointments, undertaking shopping, participating in employment, navigating unfamiliar environments and maintaining independence in daily life.

Vision 2020 therefore encourages the Committee to carefully examine the disability specific impacts of proposed reforms and to ensure that changes are informed by evidence, consultation and ongoing monitoring of outcomes.

Recommendations 2 and 3: Support Determinations While we recognise the importance of controlling the growth of the NDIS, Vision 2020 members don’t believe that support determinations of the kind proposed in this bill are the most appropriate approach. Sweeping changes to participants’ plans without consideration of their individual circumstances is philosophically incompatible with the vision behind the scheme.

We support recent proposals that would impose limits on the Minister’s power to make support determinations if they are introduced but believe these amendments wouldn’t sufficiently safeguard against unintended consequences, particularly for people who are blind or have low vision.

We do not support the inclusion of Improved Daily Living Skills within the scope of support determinations. This category contains many of the specialist capacity-building supports relied upon by people who are blind or have low vision, including orientation and mobility training, assistive technology training, low vision rehabilitation and other interventions designed to maximise independence.

While these supports are often characterised as capacity-building services, their use differs in important ways from some other forms of therapy. There is a risk that support determinations may be informed by assumptions that capacity-building supports deliver a permanent outcome after a limited period of intervention. For many people who are blind or have low vision, this assumption does not reflect lived experience.

The need for vision-related capacity-building supports routinely changes throughout a person’s life. For example:

• a participant who moves house may require orientation and mobility training to learn new routes to public transport, local services and community facilities;

• a participant whose vision deteriorates may require further rehabilitation, technology training or orientation and mobility support to continue undertaking tasks they were previously able to perform independently;

• changes in employment, study or community participation may create entirely new support requirements that were not previously present. For this reason, ongoing access to capacity-building vision supports should not be viewed as evidence of ineffective intervention or unnecessary service use. Rather, it reflects the

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reality that blindness and low vision are lifelong conditions experienced within changing environments.

Vision 2020 is also concerned that limitations in current NDIS data may make it difficult to accurately assess the use and value of blindness-specific supports.

Historically, several specialist vision services have not been captured through dedicated support line items. As a result, data may show participants receiving many supports from a single provider without adequately distinguishing between the different services being delivered. In practice, those services may include orientation and mobility instruction, assistive technology training, occupational therapy, communication support, independent living skills training and low vision rehabilitation.

The recent introduction of a dedicated Orientation and Mobility line item is a welcome development and should improve transparency regarding support utilisation. Vision 2020 ``-hopes that additional vision-specific support categories will be introduced over time. However, until more complete data is available, there is a risk that support determinations will be developed based on an incomplete understanding of how blindness-specific supports are delivered and used.

The blindness and low vision community provides a clear example of why broad, scheme wide funding controls can have disproportionate impacts on particular disability cohorts, even where this is not the Government’s intention. Measures that appear neutral when viewed across the whole Scheme may produce significantly different outcomes for cohorts whose support needs arise from environmental barriers, changing functional capacity and lifelong rehabilitation requirements.

Accordingly, Vision 2020 recommends that support determinations should not apply to Improved Daily Living Skills supports. In addition, before making any support determination, the Minister should be required to commission and publish disability specific impact analysis examining the likely effects of the proposed determination on affected disability cohorts.

Such analysis would improve transparency, support evidence-based decision-making and reduce the risk of unintended consequences for participants whose support needs may not be readily apparent in aggregate NDIS data.

Recommendations 4 and 5: Social and Community Participation Supports Vision 2020 strongly supports the proposed amendment ensuring that reductions to social and community participation funding cannot affect supports that participants require to manage their health, attend medical appointments, engage in employment, or undertake essential daily activities.

For many people who are blind or have low vision, social and community participation funding is not discretionary in nature. These supports are frequently used to:

• attend medical and allied health appointments;
• undertake grocery shopping and other essential errands;
• participate in exercise and physical activity;
• attend job interviews and employment-related activities;
• access community services; and

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• maintain social connections that support mental health and wellbeing. The everyday environment remains heavily dependent on vision. Inaccessible transport systems, poor wayfinding, inaccessible information and other environmental barriers create additional costs and support needs that are not experienced by most Australians.

As a result, supports funded through social and community participation budgets often perform a vital role in enabling people who are blind or have low vision to maintain their health, independence and economic participation. Reforms should recognise these realities and avoid narrow interpretations of health and wellbeing that focus only on personal care activities.

Having not seen text of the proposed amendments at time of lodgement, it is unclear how funding used for these purposes can be protected. Acknowledging the administrative burden this would place on service providers, one option might be the introduction of new line items to the pricing schedule, specifying the purpose for which supports are being used.

The implementation of proposed budget cuts, if delivered, also requires further thought. A system where a plan includes a stated budget, but some of that budget can’t be spent, will result in extreme confusion for both providers and participants. If the bill in its final form allows the Minister to make support determinations, a key goal of implementation should be that participants can clearly see the budget they have available to them.

Recommendations 6 and 7: Assessment of Permanence and Appropriate

Treatments

Establishing criteria for permanence at a legislative level, as proposed in the bill, may lead to some improvements in access decisions. As originally drafted, the bill could have resulted in people being barred from the scheme for being unable to access treatments due to factors beyond their control.

Though the text of the amendment wasn’t available at time of lodgement, Vision 2020 supports in principle the proposed amendment to the bill, clarifying that people will be eligible for the NDIS if they have attempted all treatments available through Medicare, the Pharmaceutical Benefits Scheme or the public health system.

People should not be excluded from disability supports because of an inability to access treatment that is unavailable, unaffordable or subject to significant waiting periods.

It is equally important that decisions regarding the availability and appropriateness of treatment remain grounded in clinical expertise.

In the vision sector, ophthalmologists and other specialist medical practitioners possess the expertise required to determine whether further treatment options remain available. If a suitably qualified ophthalmologist certifies that all clinically appropriate treatment options have been exhausted, this judgement should be accepted for the purposes of NDIS access.

NDIA staff are not medical specialists and should not be placed in the position of overriding or second-guessing clinical decisions regarding treatment pathways. Maintaining appropriate respect for specialist medical evidence will improve consistency, reduce disputes and ensure fairer outcomes for applicants.

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Recommendation 8: Definition of Functional Capacity`

`Vision 2020 is concerned that the proposed section 9B requires functional capacity to be assessed in a context that excludes, as far as possible, the impact of environmental circumstances. While this approach is designed to deliver more consistent decision making, this definition may make it more difficult for assessors to measure the functional capacity of people with a vision impairment.

Navigating a street is impossible to conceptualise separately from the street. Reading information is impossible to conceptualise separately from the format in which the information is presented. Preparing food is impossible to conceptualise separately from the kitchen in which it is being prepared. Travelling independently is impossible to conceptualise separately from the accessibility of the transport system being used.

In other words, we’re concerned that the impact of vision impairment may not be separable from the environment in which a person is living, travelling, working and participating.

The same individual may demonstrate markedly different levels of functional independence depending on whether they are operating in an accessible or inaccessible environment. Assessment processes that seek to exclude environmental circumstances therefore risk overlooking the very barriers that create disability-related support needs.

This concern reflects a broader principle underpinning contemporary disability policy. The social model of disability recognises that disability arises not simply from an individual’s impairment, but from the interaction between impairment and environmental barriers. To exclude environmental circumstances from consideration risks reintroducing a medicalised understanding of disability that focuses exclusively on an individual’s impairment while overlooking the barriers that restrict participation. For people who are blind or have low vision, those barriers are often the primary reason supports are required.

The practical consequences of this definition for blind and low vision participants have not been demonstrated. Vision 2020 is not aware of any public testing, evaluation or disability specific impact analysis examining how the definition would operate for participants whose support needs arise largely from environmental barriers and accessibility challenges.

In the absence of such evidence, the proposed definition risks creating unintended consequences for people who are blind or have low vision and may produce assessment outcomes that do not accurately reflect real-world support needs.

The proposed definition of functional capacity in section 9B should not be included in the Bill. Any future definition should be developed through genuine co-design with people with disability and representative organisations and should be subject to testing across a range of disability cohorts, including people who are blind or have low vision, before being incorporated into legislation.

Recommendation 9: Retaining Streamlined Access Pathways

Vision 2020 recognises the Government’s objective of improving consistency and transparency in NDIS access decisions. We also acknowledge concerns raised regarding the operation of Access Lists A and B, including situations in which individuals with significant vision impairment have experienced barriers to access because their particular diagnosis was not explicitly identified within the lists.

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However, shortcomings in the current arrangements do not justify the removal of all streamlined access pathways for conditions where substantial and enduring disability related support needs are well established.

The Minister has stated that access to the Scheme should be based on a significant impairment in functional capacity rather than diagnosis alone. While functional capacity is an important consideration, Vision 2020 is concerned that an exclusive reliance on functional assessment risks creating unnecessary complexity, cost and uncertainty for some groups of participants.

For people who are legally blind or who have permanent bilateral vision loss, there is already a well-established clinical and functional reality. Permanent vision loss is a lifelong condition that results in enduring disability-related support needs, even where an individual has developed substantial skills and independence through training, rehabilitation, assistive technology and environmental adaptation.

Replacing all diagnosis-based or streamlined access mechanisms with generalised functional assessment processes could create unnecessary administrative burdens for participants whose long-term support needs are already well understood. Requiring extensive functional assessment processes in such cases may increase costs for both participants and the Agency without improving the accuracy of access decisions.

The blindness and low vision sector therefore supports retaining a streamlined access pathway for people who are legally blind or who have permanent bilateral vision loss. Any reforms to existing access lists should focus on improving fairness and correcting gaps in coverage, rather than removing streamlined arrangements altogether.

Recommendation 10: Plan Suspensions and Accessible Communication

Vision 2020 is concerned about provisions that would allow participant plans to be suspended where the NDIA considers that reasonable attempts have been made to contact a participant.

This legislation, in its final form, should require that reasonable attempts to contact a participant include communication in the participant’s preferred format. This should not be left to policy or operational guidance but should be expressly reflected in the legislation.

For people who are blind or have low vision, communication accessibility remains a significant and ongoing challenge across government and community services. Participants continue to report receiving important information in inaccessible or unusable formats despite having previously advised agencies of their preferred communication methods.

The consequences of plan suspension can be severe. Accordingly, the standard for what constitutes a “reasonable attempt” to contact a participant should be high.

While many people who are blind or have low vision use screen readers, magnification software and other assistive technologies effectively, this is not universally the case. Many participants enter the NDIS following recent or progressive vision loss and may still be in the process of learning blindness-specific skills. Some may not yet be proficient users of screen readers or magnification technology. Others may be waiting for specialist training,

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assistive technology assessments or equipment that will enable them to access information independently in the future.

In these circumstances, the mere transmission of information in an electronic format should not automatically be regarded as an accessible communication attempt. A participant who is unable to independently access a communication because they have not yet acquired the necessary skills or technology should not be considered uncontactable.

It is also important to recognise that blindness and low vision can create administrative and communication barriers that are not immediately obvious. Tasks that sighted people undertake independently and quickly—such as reading correspondence, completing forms, locating attachments, navigating online portals or responding to requests for information—may require additional support, training or assistance.

For this reason, a participant’s failure to respond should not automatically be interpreted as disengagement from the Scheme. In some cases, it may indicate that communication has not been genuinely accessible or that the participant requires additional support to engage effectively.

Vision 2020 therefore recommends that the legislation specify that reasonable attempts to contact a participant must:

• be undertaken using the participant’s recorded preferred communication format;

• include multiple contact attempts and communication methods where appropriate;

• take account of whether accessibility barriers may be preventing engagement;

• consider whether the participant may be awaiting assistive technology, training or other supports necessary to access information independently; and

• where appropriate, involve nominees, authorised representatives, support coordinators or other approved contacts before a plan is suspended.

The blindness and low vision community demonstrates why this safeguard is necessary. Participants should not lose access to disability supports because they were unable to access communications that those supports were intended to help them use in the first place.

Recommendation 11: Alternative Systems of Support

Vision 2020 supports the principle that people should access supports through the most appropriate service system. However, participants should not be excluded from the NDIS unless alternative systems are able to provide supports that are accessible, timely, appropriate and genuinely equivalent to those currently available through the Scheme.

For people who are blind or have low vision, this requires more than the existence of a generic support program. Alternative systems must be capable of providing access to the specialist services that enable independence, safety and participation.

While vision impairment effects a significant number of Australians, the proportion of people requiring specialist vision rehabilitation and disability supports remains relatively small compared to many other service groups. As a result, there are often limited market

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incentives for businesses who seek to serve a large client base to develop and maintain specialist expertise in blindness and low vision.

Policy discussions around foundational supports and alternative systems of support can sometimes focus on the existence of a program or funding stream without adequately considering whether specialist expertise will be available to participants when required.

For people who are blind or have low vision, a properly functioning alternative support system should ensure that individuals who require specialist vision services can access them regardless of where they live and regardless of how frequently those services are needed. Many participants may require only periodic intervention from specialist providers, but those interventions are often critical to maintaining independence and preventing more intensive support needs from emerging.

At present, it is increasingly difficult to sustain specialist vision service delivery outside the NDIS. In many cases, there are no alternative funding mechanisms capable of supporting the workforce, infrastructure and expertise required to deliver these services at scale. The existence of a theoretical alternative pathway is therefore not sufficient evidence that participant needs will be met in practice.

Vision 2020 Australia therefore considers that participants who are blind or have low vision should not be excluded from the NDIS unless governments can demonstrate that alternative arrangements will provide equivalent access to specialist vision supports. This should include appropriate funding mechanisms capable of sustaining specialist service delivery, maintaining workforce capability and ensuring equitable access for people living in metropolitan, regional and remote communities.

The Committee should carefully consider whether proposed alternative support systems will be capable of meeting the needs of low-incidence disability cohorts before relying on those systems as a basis for restricting NDIS eligibility or reducing access to supports. Otherwise, there is a significant risk that participants will lose access to supports that currently enable independence and participation without gaining access to a genuine alternative.

Recommendation 12: Consultation and Implementation Finally, Vision 2020 notes concerns raised across the disability sector regarding the pace of reform and the continuing development of key operational details through subordinate legislation and rules.

Given the significance of the proposed changes, it is essential that:

• people with disability and representative organisations are meaningfully involved in design and implementation;

• disability-specific impacts are assessed before major changes are introduced;

• reforms are evaluated transparently; and

• sufficient safeguards remain available to participants whose support needs may be adversely affected.

Vision 2020 supports measures that strengthen the sustainability of the NDIS and ensure the Scheme remains available for future generations.

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However, sustainability must be achieved in a way that maintains the independence, participation and quality of life of people who are blind or have low vision. Reforms should recognise the unique barriers faced by this cohort and ensure that essential supports are not inadvertently restricted through broad funding controls or narrow interpretations of need.

We welcome the amendments that safeguard funding used for health and employment participation and recognise the importance of clinically informed decisions regarding treatment pathways. We encourage the Committee to advocate for further strengthening of safeguards to ensure that `people who are blind or have low vision can continue to participate fully and independently in Australian life.

About Vision 2020

Vision 2020 is the national peak body for the eye health and vision care sector. Working with and representing almost fifty member organisations, we focus on supporting policy and funding changes to prevent avoidable blindness, enhancing eye care delivery and better meet the needs of people who are blind or living with low vision.

Our members span a wide range of areas and engage in local and global eye health and vision care, health promotion, low vision support, vision rehabilitation, eye research, professional assistance, and community support. This means that the work we do in developing sector-supported policy and advice brings a diverse range of expertise and perspectives to bear, and that the perspectives and experiences of both service users and service providers are at the heart of our work.

Avoidable blindness and vision loss in Australia, and our region, can be prevented and treated by working in partnership across government, non-government, private and community sectors. People of all ages who are blind or vision impaired will benefit from these partnerships, with improved access to services that support their independence and community participation.

For further information about this submission, please contact Vision 2020 Australia via email, policy@vision2020australia.org.au