Submission 32 — Occupational Therapy Society (OTSi) (32 | External submission

Supplementary Submission

Inquiry to the National Disability Insurance Scheme Amendment (Securing the

NDIS for Future Generations) Bill 2026

Introduction - Reason for this Supplementary Submission The Occupational Therapy Society (OTSi) thanks the Senate Committee for the opportunity to provide a supplementary submission. OTSi has:

Made an original submission to the Inquiry in May 20261
Provided a supplementary submission focused on the “appropriate treatment’ provisions in the Bill
Appeared as a witness at the Canberra Public Hearing on June 10th 20262
Provided an Opening Statement; and Policy Brief focused on Functional Capacity Assessment, at the Canberra Public hearing on June 10th, 2026.
Provided written responses to Questions on Notice at the Canberra Public hearing on June 10th, 20263 focused on functional capacity assessment.

The OTSi makes this supplementary submission because our concerns regarding participant safety have significantly escalated since lodging our original submission and remain unaddressed following the publication of the Senate Inquiry Interim report4 on the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.

As occupational therapists and allied health professionals, we have an ethical and professional duty to speak when we believe reforms create foreseeable risks of harm. Participant safety is not a peripheral issue within disability reform; it is a primary obligation of every health profession. We therefore consider it necessary to place on record our escalating concern that the Bill, if implemented without substantially stronger safeguards, creates clear and foreseeable risks to the safety and wellbeing of NDIS participants.

1 Submission no. 32 Submissions – Parliament of Australia 2 Public Hearings – Parliament of Australia 3 No. 10 Additional Documents – Parliament of Australia 4 Interim Report National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 – Parliament of Australia

Senate Community Affairs Legislation Committee Interim Report

Consideration of Safety Risks Associated with Loss of Essential Disability

Supports and NDIS Eligibility

The OTSi contributions to the Inquiry identified numerous safeguarding risks arising from the Bill, including risks associated with sudden loss of essential support, reduced access to therapy, risks associated with mandatory assessments, diminished participant safeguards, increased standardisation, automation, reduced procedural fairness, increased risk of institutionalisation and group home living, and broad powers to reduce supports without adequate individual risk assessment.

Since our original submission, the Senate Community Affairs Legislation Committee has released its interim report. OTSi is deeply concerned that it does not adequately engage with the extensive evidence of concern provided regarding participant safety. Thousands of submissions to this inquiry described risks of harm arising from reduced supports, diminished safeguards and withdrawal of essential services. In our view, the central question of participant safety remains largely unaddressed.

The Senate Community Affairs Legislation Committee Interim Report on the National Disability

Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 acknowledges concerns that proposed reforms may reduce access to disability supports and tighten eligibility for the NDIS. While the report recognises participant safety as an important policy consideration, it provides only limited assurance that safety risks associated with the withdrawal of essential supports or complete loss of NDIS access will be adequately mitigated.

The report records extensive evidence from stakeholders expressing concern that stricter eligibility criteria, revised permanence tests, functional capacity assessments, narrower definitions of reasonable and necessary supports, and greater reliance on other service systems may result in some people losing access to the Scheme or experiencing reductions in essential supports. Stakeholders argued that these changes could expose participants to increased risks of harm, particularly where alternative disability or mainstream services are unavailable, inaccessible or unable to meet their needs. The committee summarises these concerns throughout its discussion of eligibility, support determinations and funding gaps, including specific concerns regarding “gaps” between the NDIS and foundational or mainstream services.

The report identifies several legislative safeguards intended to reduce these risks. Most notably, it notes that the Minister must have regard to participant safety when making support determinations that reduce funding for specified categories of supports. However, the report also acknowledges that the legislation provides limited detail about how this safety obligation will operate in practice. Consequently, Recommendation 2 calls for the Explanatory Memorandum to clarify the mechanism through which the Minister must consider participant safety, including the safeguards and monitoring arrangements that will accompany support determinations.

OTSi notes that the Exploratory Memorandum (EM) has indeed been amended5 following the Interim report apparently in response to Recommendation 2. However, the amendments state that ministerial determinations reducing funding for categories of supports, including Capacity Building Daily Living (CBDA), and Social, Community and Civic Participation (SCCP), are unlikely to affect participants’ health, safety, or continuous care needs. It further states that these cuts are not intended to adversely affect participants. OTSi considers the assertion that cuts, to both CBDA and SCCP funding respectively, are unlikely to adversely affect participants, is inaccurate. For many participants, funding for CBDA and SCCP directly supports health, safety and continuity of care, despite carve-outs for some aspects of SCCP funding that relate to attending medical appointments and employment. Blanket reductions to these funding categories therefore have the potential to adversely affect participants’ health, safety and ongoing support needs.

OTSi is concerned that reduced access to CBDA therapy funding is also likely to occur through the standardisation and capping of support budgets. Reductions to CBDA (therapy) funding may have significant implications for participant health, safety and continuity of care. Therapies such as occupational therapy, physiotherapy, psychology and speech pathology are essential elements of participant support. for many NDIS participants they are essential supports that maintain functional capacity, prevent deterioration, manage risks, monitor changing needs, and support safe participation in daily activities. Reduced access to therapy may result in functional decline, increased reliance on crisis or acute services, delayed identification of emerging risks, and disruption to established multidisciplinary care. As a result, reductions to therapy funding have the potential to compromise participant safety and continuity of care, particularly where alternative services are unavailable or unable to meet participants’ ongoing support needs.

The amended EM further states that participants who believe they are at risk following funding reductions arising from ministerial determinations should seek an unscheduled plan reassessment, which may also be initiated by the NDIA. However, other provisions of the Bill introduce stricter eligibility criteria for unscheduled reassessments and extend the timeframe for the NDIA to make a decision. It is therefore unclear whether reassessment processes following funding reductions will

5 Revised Explanatory Memorandum - NDIS Bill No. 1

occur quickly enough to mitigate safety risks for participants who experience significant cuts to essential supports.

The EM also states that ministerial determinations must consider system-level and population-level impacts of funding reductions under section 34 of the Act. However, it does not require consideration of impacts on individual participants, despite safety risks arising at the individual level. OTSi therefore emphasises the importance of individual risk assessments whenever participant funding is reduced, including through ministerial determinations made under section 34.

OTSi notes that the impact statements published alongside the Bill have subsequently been amended to clarify that a greater number of participants will experience reductions to social and community participation funding than was originally indicated. Taken together, these factors indicate significant risks for participants that are not adequately addressed in the Senate committee’s interim report on the Bill.

Similarly, the committee recognises concerns about participants falling between the NDIS and proposed foundational supports. The report notes stakeholder evidence that foundational supports are not yet established and that uncertainty remains regarding what services will be available to people who no longer qualify for the NDIS. In response, the committee recommends that governments implement the National Cabinet commitment to establish and fund foundational supports outside the Scheme, recognising these supports as an important component of broader reform. However, the report does not establish mechanisms to ensure continuity of support for individuals who lose NDIS eligibility before these alternative systems are fully operational.

Further, while the report discusses safeguards relating to automated administrative action, these safeguards are directed primarily towards advance notice of the introduction of automated processes, rather than preventing harm arising from withdrawal of disability supports. Likewise, provisions relating to review processes, reassessments and consultation are intended to improve NDIS administrative consistency but do not create explicit protections against adverse safety outcomes following reduced funding or loss of eligibility. For example, funding caps under s33 (2EA) may be automated or become embedded in an algorithm, leading to support reduction without consideration of individual impacts, such as loss of housing and forced entry to group home settings, and impact on people living with multiple impairments.

Overall, the Interim Report recognises that participant safety is a legitimate concern and recommends additional clarification about safety safeguards. However, it stops short of recommending mandatory risk assessments, continuity-of-support arrangements, transition planning, monitoring of adverse outcomes, or statutory protections for participants, who have already proven permanent disability and NDIS eligibility, who lose access to essential supports or cease to qualify for the NDIS. Consequently, the report addresses safety principally as a matter requiring further policy clarification rather than as a core legislative safeguard embedded within

the Bill itself. The report fails to adequately consider the need for legislative safeguards within the primary legislation.

OTSi is deeply concerned that it does not adequately engage with the extensive evidence provided regarding participant safety. Hundreds of submissions to this inquiry described risks of harm arising from reduced supports, diminished safeguards and withdrawal of essential services. In our view, the central question of participant safety remains largely unaddressed.

Emerging Evidence of Safety Risks Since lodging our original submission, OTSi members across Australia are already reporting substantial reductions in participant plans and supports. We are hearing consistent reports of significant cuts to therapy, capacity-building supports, assistive technology, support coordination and community participation. These concerns are already reflected in media reporting6 7 8and as mentioned, have been raised consistently across submissions and testimony to the inquiry.

These reductions are occurring before many of the proposed legislative proposals have been fully scrutinised, and before foundational supports are available across Australia.

Occupational therapists routinely assess and support participants to manage risk across multiple domains including falls, pressure injuries, mental health deterioration, functional decline, medication management, cognitive impairment, family violence, safeguarding, parenting capacity, hospital avoidance and community participation. Withdrawal of disability supports changes those risks.

The cumulative effect of the reforms described in our original submission has the potential to increase:

preventable hospital presentations and admissions;
functional deterioration resulting from loss of maintenance therapies;
mental health deterioration associated with social isolation and withdrawal of community participation;
falls and injury associated with reduced equipment and environmental supports;
carer burnout and family breakdown;
child protection involvement where disability-related parenting supports are withdrawn;
homelessness and housing instability;
avoidable entry into residential care or institutional settings; 6 A Perth man who has lived with paralysis for 38 years says he is facing the possibility of losing his home after NDIS funding cut.

Video | Facebook

7 She won gold for her country. Now a cut to her NDIS plan has stripped her of independence | 7NEWS

8 The NDIS has given Joe vital social skills. Funding cuts leave his mother fearing how he will ‘do life’ | National

disability insurance scheme | The Guardian

suicide risk for participants experiencing abrupt loss of essential supports; and
the risk of increased death rates. These are not speculative concerns. They represent well-recognised clinical consequences when essential disability supports are removed without appropriate transition planning.

Safety Risks Identified in OTSi’s Original Submission Remain Unaddressed Our original submission identified numerous provisions that create foreseeable safety risks, including:

repeal of section 31 and erosion of participant-directed planning;
Ministerial powers to reduce funding without individual reassessment;
narrowed definitions of functional capacity that risk underestimating disability in real-world settings;
permanence provisions that may lead to inappropriate treatment expectations;
reassessment and suspension powers that may disproportionately affect participants with communication barriers, executive dysfunction, psychosocial disability and fluctuating conditions;
increasing reliance on automated decision-making without adequate transparency or review;
greater reliance on unpaid family care without adequate assessment of family sustainability; and
increasing standardisation of planning at the expense of individual clinical need.
the risk that the Bill will impact Closing the gap outcomes. We add to this list, the safety concerns and distress arising from fear and uncertainty, and potential risks arising from eligibility reassessment, as has been noted in international settings when disability entitlement reassessments have been implemented.

OTSi remains of the view that these risks are cumulative rather than isolated. Considered together, they substantially increase the likelihood that participants with complex, fluctuating and/or invisible disabilities will experience administrative processes and assessments leading to reductions in supports that are clinically unsafe. Further, while new measures such as a NDIS helpline for Aboriginal and Torres Strait Islander people with disability are welcome, this step does not address harmful impacts from the Bill such as the impact on Closing the Gap, identified in the Bill Explanatory Memorandum.

Participant Safety Must Be Considered Alongside Financial Sustainability The Bill places considerable emphasis on financial sustainability.

OTSi submits that sustainability cannot be assessed solely through projected expenditure.

In health systems, reforms are routinely assessed against safety, quality and clinical risk frameworks. Decisions that reduce services are ordinarily accompanied by structured clinical risk assessments, transition planning and clear handover arrangements to ensure continuity of care.

Equivalent safeguards should apply when governments withdraw disability supports.

A reduction in NDIS funding is not simply an administrative decision. It is often a decision to withdraw services that participants rely upon to remain safe, maintain health, participate in their communities and avoid crisis.

The same principles of safe transition that apply throughout the health system should also apply to withdrawal of Commonwealth disability supports.

Additional Recommendation In addition to the recommendations contained within OTSi’s original submission, OTSi recommends the Bill be amended to require that any participant who experiences:

a substantial reduction in their NDIS plan;
withdrawal of major categories of funded supports; or
loss of eligibility for the NDIS, must receive:

A. A documented Participant Impact Assessment The assessment should identify foreseeable risks arising from withdrawal or reduction of supports, including risks to health, safety, functional capacity, mental health, housing, parenting, carer sustainability and community participation.

B. A Statement of Alternative Supports Where participants are expected to transition to mainstream, foundational or community supports, the NDIA should provide a written Statement of Alternative Supports identifying:

the services expected to replace withdrawn NDIS supports;
evidence that those services are available, accessible, timely and appropriate;
how continuity of care will be maintained;
identified service gaps; and
residual risks where equivalent supports are unavailable. C. Opportunity to grade exiting from the NDIS through step-down plans For the proposed 240,000 participants who will lose access to the NDIS under the Bill provisions, the Bill could enshrine safeguards through the establishment of graded support withdrawal and step-down plans (eg spanning 6 months for transition support), to ensure a safe transition out of the NDIS where this is the intended outcome.

These requirements reflect fundamental principles of safe clinical handover.

No health service would be regarded as providing safe care if essential services were withdrawn without assessing the resulting risks and documenting how those risks would be managed. OTSi submits that the Commonwealth should be held to the same standard when withdrawing disability supports or transitioning participants out of the NDIS.

Conclusion OTSi remains deeply concerned that participant safety has not received sufficient consideration throughout the development of this Bill.

The evidence presented to this inquiry demonstrates widespread concern that reductions in disability supports may produce significant unintended harms. The interim report does not, in OTSi’s view, adequately engage with these risks or propose safeguards proportionate to the scale of the reforms.

As allied health professionals, our obligation is to advocate for safe systems of care. We cannot remain silent where we believe foreseeable harm may arise.

OTSi therefore urges the Committee to strengthen the Bill’s safeguarding provisions, adopt the recommendations contained in our original submission, and introduce mandatory risk assessment, documented transition planning, and step-down plans, whenever participants lose eligibility or experience significant reductions in funded supports.

Financial sustainability is an important objective. However, it must never come at the expense of participant safety.