Sustaining Australia's Quality Therapy Services (Provider advocacy) | External submission

Submission 272 - Supplementary Submission

National Disability Services Submission:

National Disability Insurance Scheme

Amendment (Securing the NDIS for Future

Generations) Bill 2026

Supplementary Submission: Sustaining

Australia’s Quality Therapy Services

Submission 272 - Supplementary Submission

About National Disability Services

National Disability Services (NDS™) is Australia’s peak body for disability service organisations, and Australia’s biggest and most diverse network of disability service

providers. Our valued members collectively operate several thousand services for more than 300,000 Australians with disability and employ a workforce of more than 100,000

people.

NDS is committed to a sustainable and diverse disability service sector, underpinned by the provision of high-quality, evidence-based practices and supports that strengthen, safeguard, and provide greater choice for people with disability in Australia.

Acknowledgement of Country

NDS acknowledges the Aboriginal and Torres Strait Islander peoples as the Traditional

Custodians of the lands, waters, and skies where we live, learn and work. We pay our respects to Elders past, present, and future and honour the enduring cultural authority, knowledge systems, and Ways of Knowing, Being and Doing that continue to strengthen communities across Australia.

Submission 272 - Supplementary Submission

Contents

About National Disability Services ……………………………………………………………………… 2

Acknowledgement of Country …………………………………………………………………………… 2

Contents ……………………………………………………………………………………………………… 3

Executive Summary and recommendations ……………………………………………………. 4
Introduction ………………………………………………………………………………………………. 8
Defining Functional Capacity ………………………………………………………………………… 9
Ministerial support determination powers ………………………………………………………. 11
Independent and Evidence-based pricing……………………………………………………….. 12
Reasonable and necessary supports …………………………………………………………….. 15
Meaning of permanence …………………………………………………………………………….. 16
Implementation and Foundational supports ……………………………………………………. 17
Conclusion ……………………………………………………………………………………………… 20 Contact ……………………………………………………………………………………………………… 20

Submission 272 - Supplementary Submission

Executive Summary and Recommendations National Disability Services (NDS) welcomes the opportunity to provide this supplementary submission to the Senate Community Affairs Legislation Committee on the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (the Bill).

This supplementary submission focuses on a critical issue for NDS members and the

people with disability they support: the future of Australia’s quality therapy services.

Quality disability therapy is not an optional support within the NDIS. It is a core investment that keeps people safe, builds independence and supports the long-term sustainability of the Scheme.

Quality therapy is delivered where life happens, in homes, schools, workplaces and community settings, so people can build and use skills in everyday life. It supports people with complex and lifelong disability, helps manage risk, enables key life transitions and

strengthens the capability of families, carers and frontline workers.

Quality therapy is also more than the hours delivered in a therapy session. It relies on clinical expertise, evidence-informed practice, supervision, safeguarding, coordination,

reporting and collaboration across systems. These activities are essential to safe, effective and high-quality support.

NDS members providing therapy supports have consistently raised concerns that current

and proposed reform settings risk weakening access to the very services the NDIS depends on to improve outcomes, support independence and reduce future support needs. These concerns include pricing, funding for travel to deliver supports in natural

settings, workforce sustainability, supervision, clinical governance, non-billable work, multidisciplinary practice, and access to services for participants with complex needs, particularly in regional, rural and remote communities.

NDS supports the intent of the Future Generations reforms and welcomes measures that

strengthen the sustainability and integrity of the NDIS. However, how sustainability is

Submission 272 - Supplementary Submission

achieved matters. Reducing access to quality therapy risks undermining the outcomes the

reforms are intended to deliver.

Without a strong quality therapy market, early intervention may be delayed, functional decline may increase, risks may escalate, and participants may require more intensive supports over time. Costs do not disappear; they shift to families, providers, mainstream services and other parts of the care and support system.

To support both participant outcomes and long-term Scheme sustainability, the NDIS

must:

Protect what works

Maintain access to evidence-based therapy and a sustainable therapy market Focus on long-term outcomes
Prioritise independence, participation, maintaining function and preventing escalation, not solely short-term cost control.

Fund quality appropriately

Recognise the real cost and value of quality therapy, including safeguarding, supervision, clinical governance, coordination, reporting, travel, workforce

development and delivery in everyday environments.

A sustainable NDIS requires a sustainable therapy market. If pricing, funding and implementation settings do not reflect the real cost and value of quality therapy,

participants may lose access to skilled supports, providers may be forced to reduce services or withdraw from complex and regional markets, and costs may rise elsewhere across the system.

This submission makes six recommendations to ensure the reforms introduced through the Bill protect access to best practice therapy services and support the sustainability of the quality therapy market.

Submission 272 - Supplementary Submission

Recommendation 1: Functional Capacity

Amend the definition of functional capacity to explicitly recognise the interaction between impairment, environmental factors and personal circumstances, and ensure ongoing engagement with people with disability, therapy providers and clinical experts in the design, implementation and continuous improvement of

Functional Capacity Assessments.

Recommendation 2: Ministerial Support Determination Powers

Undertake and publish an evaluation of the impact of the Capacity Building Daily Activities budget reset on participant outcomes, access to quality therapy, the allied health workforce and the sustainability of the quality therapy market before making further support determinations affecting therapy supports.

Recommendation 3: Independent and Evidence-Based Pricing

Establish an independent, evidence-based NDIS pricing framework, with pricing responsibility transitioning to an independent statutory pricing authority. Pricing decisions should reflect the real cost of delivering quality therapy services, including supervision, clinical governance, non-billable work, coordination, travel, workforce development and delivery in everyday environments.

Recommendation 4: Reasonable and Necessary Supports

Amend proposed subsections 34(1E) and 34(1F) to ensure the reasonable and necessary framework continues to support evidence-informed decision-making by allowing consideration of all relevant evidence, including evidence of participant outcomes and the effectiveness of supports in achieving long-term independence, participation and Scheme sustainability.

Recommendation 5: Meaning of Permanence

Ensure implementation guidance defines “appropriate treatment” as treatment that is evidence-based, available, accessible, affordable and culturally safe in the

individual’s circumstances. 6

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Recommendation 6: Implementation and Foundational Supports

Ensure foundational supports and other complementary reforms are established, adequately funded and operational before participants are expected to rely on them as alternatives to NDIS-funded supports, and that implementation is underpinned by nationally consistent design, quality commissioning, sustainable funding and effective integration across service systems.

Quality therapy keeps people safe, builds independence and reduces long-term costs. Without it, outcomes worsen and costs rise elsewhere. Protecting access to quality

therapy and the sustainability of the providers that deliver it is not separate from NDIS sustainability — it is fundamental to it.

Submission 272 - Supplementary Submission

Introduction National Disability Services (NDS) welcomes the opportunity to provide this supplementary submission to the Senate Community Affairs Legislation Committee on the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (the Bill). NDS has consistently supported the intent of the Bill and welcomes measures that strengthen the sustainability and integrity of the NDIS.

Our previous submission addressed the broader legislative framework, implementation

risks and recommendations for improvement. This supplementary submission focuses on a critical issue: the future of Australia’s quality therapy providers and services.

Quality disability therapy is a core investment that helps people with disability build and maintain functional capacity, participate in everyday life, navigate key life transitions and reduce reliance on more intensive supports over time. Therapy providers play a critical role in supporting people with complex and lifelong disability, building capability in

families and support workers, and helping participants maintain independence, safety

and quality of life.

The Bill introduces significant changes to access, planning, assessment, funding and implementation arrangements that will shape how therapy services are accessed, funded and delivered. While NDS does not oppose the intent of these reforms, we are concerned about their cumulative impact on participant access to quality therapy services, provider

sustainability and workforce capacity. Recent pricing and travel decisions have already

created pressure in parts of the therapy market, particularly for providers supporting people with complex needs and those in regional, rural and remote communities.

To support both participant outcomes and long-term Scheme sustainability, the NDIS must:

Protect what works

Maintain access to evidence-based therapy and a sustainable therapy market. 8

Submission 272 - Supplementary Submission

Focus on long-term outcomes

Prioritise independence, participation and maintaining function. Fund quality appropriately
Recognise the full cost of delivering safe, effective and evidence-based therapy services.

As the reforms enabled by the Bill introduce new access pathways, planning

arrangements and foundational supports, therapy providers will play an increasingly important role in helping participants move between NDIS, early childhood intervention, foundational and mainstream supports. Well-managed transitions help maintain continuity of support, preserve functional capacity, and reduce the risk of participants requiring more intensive supports over time.

A sustainable therapy market is therefore not simply a provider issue; it is fundamental to achieving the participant outcomes and long-term sustainability objectives that underpin

the Future Generations reforms.

This submission provides six recommendations relating to functional capacity, support

determination powers, pricing, reasonable and necessary supports, permanence and foundational supports.

Defining Functional Capacity Why this matters

The Bill places greater emphasis on Functional Capacity Assessment as a foundation for future access and planning decisions.

NDS supports greater consistency in assessment. However, functional capacity should reflect how a person functions in everyday life and recognise the interaction between impairment, environmental barriers, personal circumstances and available supports.

Submission 272 - Supplementary Submission

The way functional capacity is defined will have significant implications for access to the

NDIS and future demand for therapy services. An assessment framework that is overly narrow risks underestimating support needs and failing to recognise the role therapy plays in maintaining function and independence over time.

The Committee’s interim report recognised the importance of further consultation and clarity regarding Functional Capacity Assessment. NDS strongly supports this approach and considers ongoing engagement with people with disability, therapy providers and clinical experts essential to implementation.

NDS recommends

To support implementation of the Committee’s recommendations, NDS recommends the Government:

Amend the definition of functional capacity to explicitly recognise the interaction between impairment, environmental factors, and personal circumstances.
Ensure that the recently announced Technical Advisory Group considers structured input from people with disability and providers (including quality therapy providers), to provide ongoing advice to Government on:

o the threshold for substantially reduced functional capacity.

o the design and implementation of Functional Capacity Assessments.

o operational issues arising during implementation; and

o continuous improvement of the assessment framework.

Publish regular communiqués from the Technical Advisory Group outlining issues considered, advice provided and implementation progress to promote transparency and confidence across the sector.
Continue structured engagement with people with disability, quality therapy providers and jurisdictions throughout the design, testing, and rollout of Functional

Capacity Assessments.

Submission 272 - Supplementary Submission

Ministerial Support Determination Powers Why this matters

The proposed Ministerial support determination powers that apply to old framework plans are among the most significant reforms in the Bill. They provide the Minister with the ability to determine maximum funding amounts, support intensity, support ratios, and other funding parameters for classes of supports.

The Government has already indicated how these powers will be exercised through its announcement to reset participant budgets for Capacity Building Daily Activities by 10 per cent from 1 October 2026, alongside reductions in Social, Community and Civic Participation. Government has also announced the establishment of the Inclusive Communities Fund to strengthen genuine social and community participation.

NDS supports the Government’s objective of improving community participation and ensuring Scheme investment is directed towards supports that deliver the greatest benefit

for participants.

However, the proposed Ministerial support determination powers create significant uncertainty regarding future access to therapy supports.

The Government has stated that the proposed Capacity Building Daily Activities budget reset will not affect supports that are essential to participants’ critical care and daily living needs. However, there remains limited evidence regarding the impact of these changes on

access to therapy services, participant outcomes and market sustainability.

This uncertainty is particularly significant given existing pressures on the therapy market, including workforce shortages, reductions in therapy-related funding and recent changes to travel funding arrangements.

Before additional support determinations affecting therapy are made, Government should evaluate the impact of these reforms on participant outcomes, access to therapy services

and provider sustainability.

Submission 272 - Supplementary Submission

NDS recommends

NDS recommends the Government undertake and publish an evaluation of the impact of

the Capacity Building Daily Activities budget reset on participant outcomes, access to quality therapy, the allied health workforce and the sustainability of the quality therapy market before making further support determinations affecting therapy supports.

Where risks to participant outcomes, access to quality therapy or market sustainability are identified, the Government should be required to address or mitigate those risks

before proceeding with further determinations.

Independent and Evidence-Based Pricing Why this matters

Quality therapy in the NDIS depends on a sustainable provider market.

Therapy providers have consistently advised that current pricing arrangements do not

reflect the realities of delivering disability-specific therapy services, particularly for participants with complex needs and those living in regional, rural and remote communities.

Unlike health-based therapy models, NDIS therapy frequently involves significant non

billable work, multidisciplinary coordination, supervision, reporting, family and support worker coaching, and service delivery in homes, schools and community settings.

Pricing decisions that fail to recognise these costs jeopardise workforce sustainability,

limit investment in quality and reduce participant access to specialised supports.

For this reason, NDS continues to advocate for an independent, transparent and evidence-based approach to NDIS pricing.

Therapy pricing, including ECI, has effectively been frozen over consecutive years, while recent decisions have reduced travel and jurisdictional loadings. Decisions to reduce pricing for some disciplines such physiotherapy, have also placed pressure on quality

providers delivering these supports.

Submission 272 - Supplementary Submission

This has occurred against a backdrop of:

Rising wages and on-costs (including superannuation) across allied health professions. Recent Fair Work Commission decisions related to gender undervaluation have seen award wages for allied health professionals increase significantly. These increases must be passed on to workers with the increased

cost being absorbed by providers.

Workforce shortages and attrition.
The need to support and train new graduates.
Supervision and clinical governance requirements required to deliver best practice and evidence-based supports.
Extensive non-billable activities (assessment, reporting, liaison with NDIA and other services).
Travel and natural-environment delivery costs, especially for early childhood services.

These issues have been exacerbated by benchmarking NDIS therapy against health markets (including MBS and private health insurance), which are not appropriate comparators for NDIS practice.

The NDIS is a long-term disability support scheme that funds coordinated, capacity-building supports for people with significant and ongoing disability. NDIS therapy

involves higher participant complexity, substantial non-face-to-face workload, frequent delivery in homes, schools and community settings, and greater regulatory and quality obligations than health pricing models assume.

Benchmarking against health markets fails to account for disability-specific assessment

and reporting, coordination across multiple systems, family and carer training, crisis response and ongoing functional support needs. These activities are essential for participant outcomes but are not reflected in episodic, clinic-based health pricing

structures.

Submission 272 - Supplementary Submission

The NDIA Independent Pricing Committee acknowledged that existing benchmarking data

has material limitations and does not adequately reflect client complexity, regional variation or NDIS-specific delivery models. Continued reliance on these benchmarks risks under-pricing, workforce attrition and reduced access to quality therapy supports.

The NDIS therapy model is structurally, operationally and purposefully different. Pricing

must reflect these realities if therapy supports are to remain safe, available and sustainable.

The National Best Practice Framework for Early Childhood Intervention (the National

Framework) released in 2025 sets out what high-quality, evidence-informed ECI should look like for children and families. As Stephen Duckett highlighted in his review of art and music therapy in the NDIS, funding arrangements must actively support these policy aspirations. He noted that the current fee-for-service, line-item model is “not conducive” to the holistic, family-centred and integrated approaches envisaged in the National Framework, and recommended the NDIA consider alternative funding methods more aligned with best-practice early intervention. Pricing for ECI must therefore reflect the real

cost of multidisciplinary, natural-environment and capacity-building practice so providers can deliver the quality expected by government and families.

The legislation should:

require pricing decisions to be independent from short-term fiscal or budget sustainability pressures.
establish statutory pricing principles focused on quality, safeguarding, workforce capability, sustainability and continuity of supports.
require pricing methodologies, assumptions and supporting evidence to be publicly released.
embed structured consultation with participants, providers and the disability sector.

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support differentiated pricing arrangements that reflect the real cost of delivering complex, high-intensity, regional, after-hours and safeguarding-intensive supports.
require regular independent review of pricing adequacy, market impacts and provider sustainability.

NDS recommends

The Bill should establish an independent, evidence-based NDIS pricing framework, with pricing responsibility transitioning to an independent statutory pricing authority. The

framework should require pricing decisions to reflect the real cost of delivering quality therapy services, including supervision, governance, non-billable work, coordination, travel, workforce development and delivery in everyday environments.

6. Reasonable and necessary supports

Why this matters

The Bill amends the reasonable and necessary framework to support greater consistency in funding decisions. NDS supports this objective.

The proposed amendments allow the NDIA CEO to place less weight on particular forms of evidence when determining whether a support is reasonable and necessary.

NDS supports consistent decision-making. However, decision-making should continue to consider all relevant evidence, including evidence regarding participant outcomes, clinical

effectiveness and long-term benefits.

For therapy services, a narrow approach to evidence risks overlooking interventions that help maintain functional capacity, prevent decline and reduce reliance on more intensive supports over time.

The success of the reforms enabled by the Bill will depend not only on consistent decision-making but on ensuring decision-makers can continue to consider the full range of relevant evidence available to them.

Submission 272 - Supplementary Submission

A narrow approach to evidence risks undervaluing therapy interventions that deliver

significant long-term benefits for participants and the sustainability of the Scheme.

NDS recommends

NDS recommends amending proposed subsections 34(1E) and 34(1F) to ensure the reasonable and necessary framework continues to support evidence-informed decision making by allowing consideration of all relevant evidence, including evidence of participant outcomes and the effectiveness of supports in achieving long-term

independence, participation, and Scheme sustainability.

Meaning of permanence Why this matters

NDS acknowledges the Government’s amendments to clarify the operation of the permanence provisions, including changes intended to make it clear that applicants are not expected to undertake treatment beyond all appropriate treatment. These

amendments provide greater clarity than the original drafting.

NDS remains concerned that increasing emphasis on permanence, treatment history and remediation may create unintended barriers for some people with disability.

For many people, particularly those with psychosocial disability, neurodevelopmental disability or fluctuating conditions, permanence cannot be assessed solely through static medical evidence or treatment history.

The requirement to have undertaken all appropriate treatment may also disadvantage people who are unable to access therapy due to workforce shortages, cost, geographic location or service availability.

This risk is particularly significant in regional, rural and remote communities and for people facing social, cultural or economic barriers to care.

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Implementation guidance should therefore make clear that appropriate treatment must

be evidence-based, available, accessible, affordable and culturally safe in the individual’s circumstances.

NDS recommends

NDS recommends that implementation guidance define “appropriate treatment” as treatment that is evidence-based, available, accessible, affordable, and culturally safe in the individual’s circumstances.

Implementation and Foundational supports Why this matters

The Future Generations reforms are one part of a broader transformation of disability supports. Their success will depend not only on legislative change within the NDIS, but on the availability, quality and accessibility of supports outside the Scheme.

Many of the reforms enabled by the Bill assume participants will increasingly move

between NDIS supports, foundational supports and mainstream systems. This places greater importance on ensuring that appropriate supports are available when participants need them and that transitions between systems are well coordinated. Therapy providers will play an important role in supporting those transitions. Well-managed transitions help maintain continuity of support, preserve functional capacity and reduce the risk of participants requiring more intensive supports over time.

NDS supports investment in foundational supports and measures that strengthen connections across disability, health, education and community services.

Foundational supports should build on existing services, improve system integration and provide clear pathways for people with disability and their families.

However, participants should not be expected to rely on alternative supports before those supports are established, adequately funded and operational in practice. Poor sequencing

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of reforms risks creating service gaps, reducing access to supports and undermining

participant outcomes.

There is also a risk that costs associated with unmet need will not disappear but instead shift elsewhere across the disability ecosystem. Where supports are unavailable, participants and families may experience delays in receiving assistance, needs may escalate, and pressure may increase on mainstream systems and higher-intensity services. Therapy providers may also be required to absorb additional unfunded work, including coordination, navigation, transition support and responding to emerging needs

where appropriate services are not yet available. This can adversely affect provider sustainability and reduce capacity to deliver funded supports. This concern reflects NDS’s broader position that unmet need and service gaps ultimately create costs elsewhere in the system.

To support successful implementation, foundational supports should be guided by the following principles:

nationally consistent implementation that strengthens integration across disability, health, education and community services.
genuine and ongoing partnership with people with disability, families, providers and governments in design, implementation and evaluation.
commissioning approaches that support quality, capability, innovation and long- term market sustainability. Commissioning should prioritise providers who demonstrate best practice and a commitment to quality.
funding arrangements that recognise workforce development, supervision, collaboration and the delivery of quality supports.
clear pathways, navigation supports and coordinated transitions between systems.
ongoing evaluation and continuous improvement focused on participant outcomes and system effectiveness.

Submission 272 - Supplementary Submission

NDS recommends

NDS recommends that governments ensure foundational supports and other

complementary reforms are established, adequately funded and operational before participants are expected to rely on them as alternatives to NDIS-funded supports, and that implementation is underpinned by nationally consistent design, quality commissioning, sustainable funding and effective integration across service systems.

Submission 272 - Supplementary Submission

Conclusion NDS supports the intent of the Bill and the Government’s commitment to improving the sustainability of the NDIS.

However, sustainability cannot be achieved simply by reducing expenditure. It requires continued investment in supports that improve outcomes and reduce future support needs.

Quality therapy services are central to that objective. They help people with disability maintain functional capacity, participate in everyday life, navigate key life transitions and avoid escalation to higher cost supports.

The reforms proposed by the Bill will significantly influence the future of Australia’s therapy market. Decisions regarding assessment, funding, pricing and implementation should therefore be made with careful consideration of their impact on participant outcomes, provider sustainability and workforce capacity.

A sustainable NDIS requires a sustainable therapy market. Protecting access to quality therapy and the providers who deliver it is fundamental to achieving both participant outcomes and the long-term sustainability objectives of the Future Generations reforms.

Contact

Michael Perusco

CEO - National Disability Services

Phone:

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