Submission to the Senate Community Affairs Legislation Committee

National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Submitted by Nikki Cousins Managing Director and Occupational Therapist Action Occupational Therapy East Maitland, NSW

I am the Director of a regional occupational therapy practice supporting adolescents and adults with complex disabilities across the Hunter, Mid North Coast, Central Coast and Greater Sydney regions of New South Wales.

Our practice provides occupational therapy services to participants requiring complex assistive technology, wheelchair and seating prescription, home modifications, functional capacity assessments, and ongoing therapy supports.

I support the need to protect the NDIS from fraud and ensure the long-term sustainability of the Scheme. However, I am deeply concerned that several provisions within this Bill will have unintended consequences for participants with disability and may ultimately increase long-term costs by delaying or reducing access to preventative supports. My concerns are based on the realities I observe every day in clinical practice.

One of my greatest concerns relates to the proposed definition of functional capacity. The Bill appears to separate functional capacity from the assistive technology, environmental modifications and support systems that enable people with disability to function safely and independently. This does not reflect how disability presents in real life. Many participants supported by my practice only achieve their current level of independence because they have access to equipment, environmental modifications and support systems.

For example:

• A participant with high-level spinal cord injury may independently mobilise around their home only because they have a powered wheelchair.
• A participant with severe physical disability may shower safely only because they have a level-access bathroom and specialised equipment.
• A participant with communication impairment may participate in decision-making only because they have access to assistive communication technology.

If these environmental and assistive supports are removed from consideration, there is a significant risk that functional capacity assessments will underestimate the true impact of disability and result in participants being denied access to supports they genuinely require. This is particularly concerning for participants with neurological conditions, fatigue-related conditions, psychosocial disability, cognitive impairment and fluctuating conditions, whose needs are often poorly captured through standardised assessments. The Bill risks replacing individualised assessment with administrative decision-making.

My practice regularly assesses participants whose circumstances are highly complex. Assistive technology and home modification recommendations require consideration of:

• Functional capacity
• Housing design
• Family circumstances
• Carer capacity
• Future progression of disability
• Pressure injury risks
• Falls risks
• Behavioural considerations
• Transport requirements
• Community participation goals

These decisions cannot be reduced to a standardised scoring system.

I am concerned that the increasing emphasis on standardisation and automation throughout the Bill will result in decisions being made based on simplified administrative criteria rather than comprehensive assessment by appropriately qualified clinicians. The participants I work with are individuals, not data points. The permanence requirements will delay essential supports. The proposed requirement for participants to pursue all appropriate treatment pathways before disability is considered permanent is likely to create significant barriers to accessing essential supports. In practice, many participants require assistive technology and home modifications immediately. A person who cannot safely access their bathroom does not become safer because they are waiting to see a specialist. A person discharged from hospital who requires a wheelchair, ramp or hoist cannot safely wait months or years while treatment options are explored. Many of the supports my practice recommends are not alternatives to treatment. They are essential risk mitigation measures that allow participants to live safely while treatment continues. The proposed provisions risk delaying access to critical supports and increasing preventable injuries, hospital admissions and carer burden.

The Bill introduces provisions allowing support categories to be reduced based on financial sustainability considerations. While sustainability is important, I am concerned about decisions being driven primarily by budgetary considerations rather than assessed need. In my experience, assistive technology and home modifications are often some of the most cost- effective supports funded through the NDIS. A bathroom modification may prevent falls, reduce support worker hours and avoid hospital admissions. A powered wheelchair may prevent pressure injuries, improve independence and reduce reliance on informal carers. A communication device may allow a participant to engage in education, employment and decision-making. Reducing access to these supports may reduce expenditure in the short term but increase costs across health, aged care, hospital and support systems over the long term.

I am concerned that the proposed framework places increasing emphasis on standardised evidence and administrative decision-making while reducing the role of treating allied health professionals. Occupational therapists undertake detailed assessments involving direct observation, environmental assessment, equipment trials, consultation with participants and carers, and risk analysis. Many of the participants we support have rare, complex or highly individualised circumstances that are not adequately represented in published research. Clinical expertise and participant-specific assessment must continue to play a central role in NDIS decision-making. The current direction of reform risks creating a system where those

With the greatest clinical complexity are least likely to have their needs appropriately understood.

As a regional provider, I am particularly concerned about the impact of these reforms on participants living outside metropolitan areas. Many of my clients already experience lengthy delays accessing specialists, equipment suppliers, builders and allied health services. The Bill appears to assume that treatment pathways, alternative service systems and specialist services are readily available. This is not the reality for many regional Australians. Participants should not lose access to NDIS supports because of theoretical treatment options or service systems that are unavailable in their local community.

I recommend that the Committee:

• Amend the definition of functional capacity to require consideration of assistive technology, environmental accessibility and support systems.
• Ensure assistive technology and home modification decisions remain based on individualised assessment by appropriately qualified clinicians.
• Amend permanence provisions to ensure participants can access essential supports while treatment pathways continue.
• Remove provisions that allow funding reductions to override assessed disability-related need.
• Retain strong recognition of treating clinician evidence.
• Prohibit fully automated decision-making for assistive technology, home modifications and complex support decisions.
• Consider the unique challenges faced by regional participants when determining access requirements.

While I support measures that improve Scheme integrity and sustainability, I am concerned that several provisions of the Bill risk moving the NDIS away from individualised, evidence-based decision-making and towards increasingly standardised and fiscally driven processes. For the participants supported by my practice, the consequences will not be theoretical. They may mean delayed access to wheelchairs, bathroom modifications, communication devices, pressure care equipment and other supports that are essential for safety, independence and participation. I urge the Committee to amend the Bill to ensure the long-term sustainability of the NDIS is achieved without compromising access to the supports that enable people with disability to live safely and participate in their communities.

Sincerely,

Nikki Cousins Managing Director and Occupational Therapist Action Occupational Therapy