Submission 4249 — I’m With You — NDIS Future Generations Bill

Submission to the Senate Community Affairs Legislation

Committee

Author and publisher

Mr. Dean Matthew Jefferson

Registered Nurse

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CEO and Founder of IM WITH YOU PTY.LTD

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Acknowledgement of Country

I’m With You acknowledges the Traditional Custodians of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples.

About the author

Dean Matthew Jefferson has been a Registered Nurse since 2014 and has worked across multiple disciplines, including acute mental health units, long-term secure mental health units, forensic nursing, surgical, medical, neurology, trauma, and sub-acute rehabilitation. This has included acquired brain injury units and spinal cord injury rehabilitation units.

Following a family member sustaining an incomplete spinal cord injury in 2022, and observing a lack of specialist understanding among a number of registered NDIS providers, I’m With You was established and built from the ground up.

Today, I’m With You Pty Ltd operates across Australia, excluding Tasmania and the Australian Capital Territory, and has recently completed the requirements for certification registration with the NDIS Quality and Safeguards Commission.

A primary driver of I’m With You is improving participants’ quality of life by ensuring every participant feels heard, safe, and supported to navigate the complexities of the disability support system.

Dean is currently studying a Master of Disability and Inclusion at Deakin University and undertaking further education to ensure the most up-to-date evidence is reflected in practice.

In recognition of this commitment, I’m With You was awarded the 2026 Excellence in Disability Support and Advocacy by the Australian Enterprise Awards.

Executive summary

This submission provides input into the NDIS reforms announced in April 2026 by the Hon. Minister Mr Mark Butler.

While we welcome reform, we hold serious concerns that aspects of the proposed changes may unintentionally harm the very system designed to support people living with disability.

These concerns are informed by recent examples of policy change and reversal, including:

1. The removal of Music Therapy on the basis of limited evidence, followed by its reintroduction as a claimable NDIS support.

2. The removal of Art Therapy on similar grounds, followed by its reintroduction as a claimable NDIS support.

3. The approval of certain “low risk” assistive technology items (e.g., iPads) during the COVID-19 pandemic to support social distancing, followed by subsequent

tightening/removal unless the item directly supports disability-related functional needs (commonly communication).

4. The introduction of the New Aged Care Reform Act in November 2024, followed by an announcement less than 12 months later that people in the aged care system would again be able to access showering support without co-contributing to personal hygiene needs.

While adjustments may have been required, the human impact of rapid policy shifts must be considered, including:

1. How many older Australians reduced essential personal hygiene due to co- contribution requirements, particularly where individuals rely on savings or a pension.

2. The downstream consequences of reduced hygiene support, including: o Increased reliance on informal carers (including elderly spouses). o Increased reliance on siblings or family members already under pressure from work, parenting responsibilities, or complex family dynamics. o Use of alternative products (e.g., baby wipes) purchased privately or through subsidy schemes. o Deterioration in activities of daily living or chronic wound management, potentially leading to avoidable hospital admissions.

We are also concerned about whether the reforms are being driven by sustainable funding design, or whether they reflect a “robbing Peter to pay Paul” approach. For example:

• If “Access to Social, Civil and Community Participation” is reduced by 50% from 1 October 2026, will diverted funding be used to address gaps created elsewhere (including in aged care)?

• With the rollout of “Thriving Kids” from July 2026, is funding being cut in other areas to support this change? This is particularly concerning given that NDIS market data indicates children aged 0–8 comprise approximately 166,000 participants, and the proposed cohort shift is approximately 160,000.

I’m With You supports responsible reform to the National Disability Insurance Scheme.

Drawing on  lived experience and  frontline service  delivery, our aim  is to provide

constructive, sustainable recommendations that improve quality of life, uphold participant safety, and align with Australia’s commitments under the United Nations Convention on the Rights of Persons with Disabilities. Breakdown of critical change 1 (as summarised by Sam Paior JP, MAICD)

1. Ministerial power to cut plan funding This change is summarised as:

   • A 50% reduction to “Access to Social, Civil and Community Participation”

commencing 1 October 2026.

• The Minister may make decisions by instrument with no review option.
• This may apply to any support category at any percentage. Our response

I’m With You objects to this change for the following reasons:

1. By signing the United Nations Convention on the Rights of Persons with Disabilities, the Federal Government commits to principles including independent living and community inclusion, supporting people to choose where and how they live and to participate in community life.

2. “Access to Social, Civil and Community Participation” is currently within Core Supports, which is flexible. In practice, providers may claim under this item even where the shift relates to other supports (e.g., personal hygiene needs under “Assistance with Daily Life”). The potential ramifications include:

   o Participants being unable to access essential services if providers have

historically used this item in place of other categories.

o  Existing  limitations around  provider  travel and reimbursement, which

already restrict community access for many participants. o Reduced equity of access for people living with disability compared to those without disability. o Disproportionate impact on people with hidden disabilities, including those who may require specific transport options due to trauma triggers or PTSD.

3. No support category should be subject to unilateral reductions by ministerial instrument without safeguards. This level of control over participant funding risks significant harm if implemented without full understanding of real-world impacts.

4. Where no review option exists, participants’ remaining pathways to challenge or seek reconsideration may be limited to: o Complaints processes (NDIS Quality and Safeguards Commission)

o Commonwealth Ombudsman

o Judicial review o Discrimination pathways

5. Depending on participant circumstances, consequences may include: o Inability to attend required appointments, including parole-related face-to face conditions, potentially resulting in breach consequences. o Inability to attend or reschedule outpatient appointments, increasing risk of health deterioration and disability-related complications. Recommendations (critical change 1)

6. Implement a national approach to the Multi-Purpose Taxi Program so people living with disability can access consistent concessions across Australia, rather than state-based variation.

7. Redesign Core Supports to reflect a clearer total funding allocation aligned to the purpose of support worker usage, consistent with the proposed scoring of the Electronic Care and Needs Scale:

• 7: 24-hour care
• 6: 20–23 hours per day
• 5: 12–19 hours per day
• 4: Up to 11 hours per day
• 3: A few days per week (requires clarification)
• 2: Once per week (requires clarification)
• 1: Less frequently
• 0: Does not require support

1. Allow a default 10% variance in Core Supports funding to cover unplanned increases in service delivery needs (noting evidence that people living with disability may experience higher rates of potentially preventable hospitalisations, though this does not apply to all disability cohorts).

2. Remove from Core Supports items/services that can be made more accountable through separate controls, including:

• Transport
• Consumables
• Meals (and other controllable items)
• Any other Core item that can be more directly regulated

Breakdown of critical change 2 (as summarised by Sam Paior JP, MAICD)

2. Ministerial power to cap maximum funding amounts This change is summarised as:

• The Minister may set maximum funding amounts for certain supports or cohorts. Our response

I’m With You has serious concerns about this change if implemented as a blanket cap, because participant needs vary significantly and complexity cannot be safely reduced to a single maximum figure.

In practice, hard caps risk:

• Creating unsafe care environments for participants with high and complex needs. • Driving avoidable hospitalisations, crisis presentations, and justice-system

involvement where supports are reduced below what is clinically and functionally required.

•  Undermining  the NDIS  principle  of reasonable and necessary supports by

prioritising budget ceilings over individualised needs. Recommendations (critical change 2)

1. Avoid blanket maximum caps  for high-complexity  participants. Where a

participant’s needs are high, complex, and evidence-based (e.g., SCI, ABI, complex mental health, forensic disability), maximum funding amounts should not be subject to a fixed cap.

2. Apply a “funding hierarchy” before NDIS expenditure is increased. Where appropriate, reforms should require that other funding avenues are explored and utilised first (where they are genuinely responsible for the support), including: o Medicare-funded services o State and territory health services o Hospital and outpatient systems o Other mainstream service systems (where applicable)

3. Introduce a threshold-based co-payment model only after safeguards are met. After a defined funding threshold (to be set transparently and reviewed regularly), a participant co-payment could be considered only where it is safe, equitable, and does not reduce access to essential supports, and where: o The participant’s capacity to contribute is assessed (income and hardship protections) o Co-payments are never applied to essential personal care, safety, or clinically necessary supports

o Co-payments do not apply to participants who are unable to contribute (including those reliant on pensions or experiencing financial hardship) o Any co-payment model includes clear exemptions for rural and remote participants where service delivery costs are higher

4. Do not introduce worker-to-participant ratios as a policy lever. Worker-to- participant ratios are not an appropriate mechanism because supports must be

   individualised and responsive to functional need, risk, and safeguarding

requirements.

5. Protect participant choice, privacy, and dignity in living arrangements. Any policy settings that indirectly force shared living or shared supports to meet a ratio or cap should be avoided. A participant should not feel compelled to share a dwelling with a stranger (who has their own disability-related needs and risks) as a means of managing system costs.

6. Link reform to a mandatory training and competency framework. If the intent is to improve quality and manage risk, the primary lever should be workforce capability, not ratios. Establish a mandatory national training framework that includes:

   o Certificate III requirements that are cohort-specific (i.e., a worker must

complete a stream aligned to the disability cohort they wish to work with, such as SCI, ABI, complex mental health, forensic disability, intellectual disability, autism) o Mandatory competency-based assessment for high-risk cohorts o Supervision and ongoing professional development requirements o Dual qualifications where appropriate (e.g., disability + mental health; disability + aged care; disability + behaviour support fundamentals) Additional recommendations for the NDIS Future Generations reforms bill

The following recommendations are provided to support the intent of the NDIS Future Generations reforms while protecting participant rights, safety, and continuity of care.

1. Embed rights-based safeguards and clear review pathways

2. Any new ministerial or Agency powers that affect plan budgets, eligibility, or support categories should include: o Clear written reasons o A right to internal review o A right to external merits review o Timeframes that prevent service interruption

3. Where instruments are used, require: o Public consultation (where practicable) o Publication of evidence and impact assessment

o Sunset clauses and scheduled evaluation

2. Protect continuity of supports during transitions
   1. For participants moved into new pathways (including early intervention or

foundational supports), implement a “no worse off” transition period (e.g., 12–24 months) to prevent abrupt loss of supports.

2. Require continuity provisions for: o Existing support worker relationships o Established routines for personal care, community access, and behaviour support o Complex care arrangements (including SCI, ABI, forensic disability)

3. Ensure that any reassessment or pathway change triggers a service continuity plan before changes take effect.

4. Define and fund “foundational supports” with national consistency

5. Establish minimum national service standards for foundational supports to avoid a postcode lottery, including: o Eligibility criteria o Service scope (what is included/excluded) o Maximum waiting times o Complaints and escalation pathways

6. Ensure foundational supports are funded to meet demand, with transparent reporting on: o Waitlists o Service availability in rural and remote areas o Workforce capacity

7. Maintain clinical and functional evidence requirements without “flip-flop” policy

8. Where evidence thresholds are applied (e.g., for therapies or assistive technology), implement: o Transparent criteria o Published evidence summaries o A structured exception pathway for complex or rare presentations

9. Avoid rapid removal/reintroduction cycles by requiring: o Pilot programs with evaluation o Staged implementation o Independent clinical advisory input

5. Improve planning quality through specialist input for complex cohorts

6. Require specialist planning pathways for participants with complex needs (e.g., SCI, ABI, forensic disability, complex mental health), including: o Access to clinicians with relevant expertise o Mandatory consultation with treating teams where consent is provided o Recognition of risk, safeguarding, and community safety requirements

7. Ensure planning decisions account for: o Transport and access needs o Rural and remote service delivery realities o Participant choice and control

8. Establish a national transport approach that supports participation

9. Create a national disability transport framework that: o Aligns concessions across states o Recognises hidden disability needs o Supports safe transport options where public transport is not appropriate

10. Ensure transport policy supports participation in: o Health appointments o Education and employment o Community and cultural life

11. Strengthen workforce capability and retention as a reform priority

12. Introduce incentives and minimum expectations for workforce development, including: o Mandatory baseline training for high-risk cohorts o Ongoing competency requirements o Supervision structures for complex supports

13. Support retention through: o Career pathways (lead roles, specialist streams) o Rural and remote loadings o Consistent pricing that reflects complexity and travel

14. Improve accountability without reducing participant choice

15. Where reforms seek to increase accountability (e.g., for meals, consumables, transport), implement: o Clear rules that are easy for participants to understand o Provider accountability mechanisms that do not penalise participants o A focus on fraud prevention that avoids creating barriers for legitimate supports

9. Commit to transparent evaluation and public reporting

10. Require annual public reporting on the reforms, including: o Participant outcomes (quality of life, participation, safety) o Hospitalisation and preventable admission trends o Wait times for assessments and supports o Rural and remote access metrics

11. Establish an independent evaluation panel with lived experience representation.

12. Ensure reforms align with the UN Convention on the Rights of Persons with Disabilities

    1. Include an explicit statement in the bill (or supporting instruments) that

implementation must be consistent with: o Choice and control o Community inclusion o Non-discrimination o Equality of access

2. Require decision-makers to consider rights impacts when applying new powers.

Section 3: Removal of the Whole Person Approach

Position

The proposed removal of a whole person approach risks fragmenting supports in a way that is clinically unsafe and practically unworkable for many participants. Disability is rarely experienced in neat categories. Many participants live with dual diagnosis or interdependent needs where psychosocial and physical impacts cannot be separated without reducing outcomes and increasing risk. Why these matters (dual diagnosis and interdependence)

A whole person approach recognizes that a participant’s disability-related needs are often mutually reinforcing across domains (physical, psychological, behavioral, cognitive, environmental, and social). Removing this lens creates a system that funds “parts” of a person while ignoring how those parts interact.

Example: traumatic spinal cord injury with PTSD

A participant who has sustained a traumatic spinal cord injury (SCI) may also experience post-traumatic stress disorder (PTSD). PTSD symptoms (hypervigilance, avoidance, panic, emotional dysregulation, sleep disturbance) can directly affect the participant’s ability to engage with essential physical supports.

In practice, this can present as:

• Refusal of personal care due to trauma triggers (touch, proximity, loss of control)

• Avoidance of clinical appointments or therapy sessions

• Escalation behaviors during transfers, showering, catheter care, bowel care, or wound management

• Reduced capacity to follow routines that prevent complications (pressure injury prevention, hydration, positioning)

If psychosocial supports are treated as separate or “non-essential” to the physical disability, the participant’s physical health can deteriorate, leading to:

• Increased risk of pressure injuries, UTIs, autonomic dysreflexia events, falls,

hospital admissions

• Greater reliance on emergency services and informal carers
• Higher long-term system costs across health and disability portfolios Safeguarding and quality implications

Removing the whole person approach weakens safeguards because it:

• Encourages inappropriate rostering (workers skilled in physical care but not trauma-informed practice)

• Increases the likelihood of restrictive or coercive practices when refusal of care is misunderstood as “non-compliance” rather than trauma response

• Undermines continuity of care and therapeutic rapport, which are essential to safe personal supports

  • Shifts risk onto families and unpaid carers when funded supports become

fragmented

A participant’s “choice and control” is not protected by splitting supports into silos; it is protected when supports are designed around the participant’s actual lived needs, including mental health impacts that directly affect engagement with physical care.

Recommendation

3. Retain a whole person approach in legislation and operational guidance, explicitly recognizing dual diagnosis and interdependent needs.

4. Require planners to consider functional impact across domains, including how psychosocial conditions affect engagement with physical supports.

5. Where dual diagnosis is present, mandate a coordinated support plan (physical + psychosocial) with: o trauma-informed practice requirements o clear escalation pathways o consistent staffing to build trust and reduce refusal-of-care risks

6. Ensure review rights and safeguards apply where funding decisions would separate supports in a way that creates foreseeable harm.

Outcome

A whole person approach is a practical safeguard. It prevents predictable deterioration, reduces hospitalization risk, supports genuine choice and control, and ensures the NDIS funds supports that reflect how disability and mental health interact in real life.

Section 4: Automatic Claw back and Automatic Plan

Renewal

Position

Automatic claw back and automatic plan renewal settings risk creating avoidable harm by removing funding access at the exact time participants may be experiencing instability, health deterioration, or service disruption. These mechanisms also undermine trust in the NDIS by making supports feel conditional, unpredictable, and administratively punitive.

Instead of automatic claw back or rigid renewal settings, the Scheme should adopt a simple, participant-centered variation pathway that keeps essential supports available while enabling quick, low-burden adjustments. Problem: why automatic claw back/renewal is unsafe

Automatic claw back and automatic renewal processes can:

• Penalize participants for circumstances outside their control (hospital admissions, carer breakdown, provider cancellations, mental health deterioration, housing instability)

• Create service gaps when funding becomes unavailable before a timely review can occur

• Increase administrative burden by forcing full reassessments for issues that are minor, predictable, or short-term

• Shift risk and workload onto families, nominees, and frontline providers who are then left managing crises without timely funding flexibility Recommendation: a Simple Variation Report to keep funding available and process minor changes

Introduce a Simple Variation Report (SVR) that can be completed by any of the following:

• the Support Coordinator
• the participant

• the plan nominee
• another authorized party (as recognised by the participant and the Agency) The SVR should be a short, standardized report that can be submitted to:

7. Maintain funding availability where the support remains required, and/or
8. Request minor variations that can be quickly processed without a complete reassessment or a formal change of circumstances process. What the Simple Variation Report should include (minimum fields)

• Participant details and consent/authorization

• Current supports impacted and why (brief)

• What has changed (if anything) and whether it is temporary or ongoing

• The requested action: o maintain funding availability, and/or o minor variation (e.g., small increase/decrease, category adjustment, short term bridging)

• Risk statement if not approved (e.g., risk of hospitalization, pressure injury, carer breakdown, missed appointments)

• Supporting evidence (optional unless high-risk): brief clinician notes, discharge summary, incident summary, or provider statement Safeguards and governance

To maintain accountability while protecting participants:

• Timeframes: SVR decisions should be processed rapidly (e.g., within 510 business days), with urgent pathways for high-risk situations.

  • Minor variation threshold: Allow a defined tolerance (e.g., up to a small

  percentage or capped dollar amount) that can be approved without full

reassessment.

• Auditability: SVRs should be logged, reviewable, and auditable, with clear reasons provided for any refusal.

• No automatic loss of essential supports: Funding should not be automatically clawed back where there are a credible risk statement and reasonable evidence that the support remains required.

• Escalation rights: Participants must retain review rights where a refusal would foreseeably cause harm or service discontinuity.

Outcome

Replacing automatic claw back/renewal with a simple variation trigger pathway will:

• reduce service disruption and prevent avoidable deterioration

• lower administrative burden for participants and the Agency

• maintain accountability through auditable reporting

• rebuild trust by ensuring the NDIS responds quickly to real-world changes without forcing participants into a full reassessment for minor, predictable variations

  Section 5: Harder to Request Unscheduled

Reassessments

Position

Any reform that makes it harder to request unscheduled reassessments must not create a system where participants are forced to deteriorate, enter crisis, or experience service breakdown before the NDIS can respond.

Section 5 should be amended too either:

• align directly with the Simple Variation Report (SVR) pathway proposed in Section 4, or

  • remove the term “unanticipated” (or equivalent narrowing language) while

keeping the intent of reducing unnecessary full reassessments. Problem: narrowing access creates foreseeable harm

Participants’ circumstances often change in ways that are real and urgent but not easily categorized as “unanticipated”. For example, changes may be:

• foreseeable but unavoidable (progressive conditions, secondary complications, carer fatigue)

• episodic (mental health fluctuations, pain crises)

• triggered by external events (housing changes, provider collapse, hospital discharge) If the system requires changes to be “unanticipated” to qualify for action, participants can be left without a practical pathway to maintain essential supports.

  Recommendation: two-tier response (minor variations vs full

reassessment)

1. Establish a low-burden pathway for minor changes (SVR) Adopt the Simple Variation Report (SVR) described in Section 4 as the default mechanism to:

• keep required funding available, and
• process minor variations quickly This pathway should be accessible via the participant, plan nominee, support coordinator, or other authorized party.

2. Preserve access to unscheduled reassessments for significant changes Where changes are substantial, high-risk, or cannot be addressed through a minor variation, participants must retain the ability to request an unscheduled reassessment.

To prevent overuse while protecting safety, reassessment requests can be supported by:

• a brief risk statement and rationale

• optional supporting evidence (e.g., discharge summary, clinician letter, incident summary)

• clear decision timeframes and written reasons Draft amendment approach (options) Option A: Align Section 5 with the SVR pathway

• Minor changes and continuity needs are handled through SVR.

• Full reassessments are reserved for major changes, with safeguards and review rights. Option B: Remove “unanticipated” while keeping current safeguards

Replace narrowing language so that reassessment triggers include changes that are:

• unanticipated OR reasonably foreseeable but unavoidable, and
• material to the participant’s safety, functional capacity, or continuity of essential supports Safeguarding and trust implications

A workable reassessment framework is a safeguard. It:

• prevents predictable deterioration and avoidable hospitalization

• reduces coercive responses to unmet need (including escalation and restrictive practices)

• supports genuine choice and control by maintaining continuity

• rebuilds trust by ensuring participants can access timely adjustments without unnecessary bureaucracy

Outcome

Section 5 should reduce unnecessary reassessments without restricting participants’ ability to respond to real-world change. Aligning Section 5 with the SVR pathway (or removing “unanticipated”) provides a practical balance between administrative efficiency and participant safety.

Section   6:   Civil  Penalties  and  Compliance  with

Information Requests

Position

Section 6 should be amended to remove civil penalty units (or equivalent punitive measures) for failing to comply with information requests, unless the request is issued as part of a formal fraud investigation with appropriate safeguards.

Applying civil penalties broadly to participants, nominees, or providers for administrative non-compliance risks creating a punitive culture that discourages engagement, increases fear, and undermines trust in the NDIS. Problem: broad civil penalties undermine safeguarding and trust

Civil penalties for non-compliance with information requests can:

•  Disproportionately impact  participants with  cognitive  disability, psychosocial

disability, low literacy, unstable housing, or limited informal supports

•  Penalize people  for  delays caused by circumstances  outside  their  control

(hospitalization, crisis, domestic violence, service disruption)

• Encourage over-collection of information and administrative burden, rather than improving outcomes

• Create a chilling effect where participants disengage from the Scheme due to fear of punishment

This approach is inconsistent with a participant-centered scheme and risks shifting the NDIS from support and safeguarding into enforcement for routine administrative matters.

Recommendation

9. Remove civil penalty units for failure to comply with routine information requests.
10. Limit penalty-based information powers to circumstances where: o there is a reasonable suspicion of fraud, and o the request is made under a formal fraud investigation pathway.

11. Where information is requested outside fraud investigations, require a supportive compliance approach: o clear explanation of what is being requested and why o reasonable timeframes and extensions as standard o accessible formats and assistance to comply o escalation to a case conference or support coordinator-led resolution before any enforcement action Safeguards if fraud investigation powers are used

If civil penalties are retained for fraud investigations, they must be paired with safeguards:

• Written notice that the request is part of a fraud investigation
• Clear scope limits (only information relevant to the suspected fraud)
• Procedural fairness and review rights
• Protections for participants who rely on nominees or providers to supply records

Outcome

Restricting civil penalties to formal fraud investigations preserves the Agency’s ability to address wrongdoing while preventing routine administrative processes from becoming punitive. This change supports safeguarding, improves engagement, and helps rebuild participant trust in the NDIS.

Section 7: Eligibility Changes (Functional Capacity,

Professional Evidence, and Safeguarding)

Position

Proposed eligibility changes that reduce the role of qualified professionals in NDIS access decisions risk creating unsafe, inconsistent, and inefficient outcomes. Eligibility and functional capacity assessments should be grounded in professional evidence and recommendations, not assessed in isolation from established clinical and functional information.

A framework that attempts to assess a person’s function without due weight to professional recommendations, or by applying a naked person concept of functional capacity (assessing function as if the person has no supports or services), risks ignoring existing evidence that the person cannot safely manage. Problem: removing professional input increases risk and delays

Where there is already credible evidence that a person cannot manage daily function

safely,   restricting   professional-led   applications   or   discounting   professional

recommendations can:

• Delay access for people with genuine disability-related needs • Increase crisis presentations (hospital, mental health, homelessness, justice

contact)

• Shift burden onto families and informal supports
• Create inequity for people who cannot self-advocate due to cognitive, psychosocial, or communication barriers The naked person functional capacity issue

Assessing functional capacity as though a person has no supports or services may be intended to standardise eligibility. However, if applied rigidly or without professional context, it can:

• Ignore how disability presents in real-world environments (home, community, transport)

  • Disregard established evidence of risk (falls, self-neglect, medication

mismanagement, behavioural escalation)

• Create perverse incentives to withdraw supports to prove impairment In many cases, the existence of supports is itself evidence of need. The question should not be can the person function with all supports removed, but rather what is the persons functional capacity and safety risk profile, and what reasonable and necessary supports are required to maintain stability. Safeguarding implications

Reducing professional input and relying on narrow functional definitions can:

• Increase the likelihood of unsafe decisions that leave people without essential supports

• Undermine early intervention, leading to deterioration and higher long-term costs

• Reduce consistency and transparency in decision-making

• Erode trust in the Scheme by making access feel arbitrary and adversarial

Recommendation

12. Preserve and strengthen the  role  of  qualified professionals  in  eligibility

applications  and  access  decisions,  including  the  ability  for  professional

recommendations to accompany and substantiate access requests.

13. Require decision-makers to give appropriate weight to: o clinical reports and diagnostic evidence o functional assessments o risk assessments (including self-neglect, falls risk, behavioural risk) o professional recommendations regarding support needs

14. If a naked person functional concept is retained, it must be balanced with: o real-world functional evidence (what occurs in daily life, not just in theory) o safety and risk considerations o recognition that existing supports may be preventing deterioration and crisis

15. Ensure review rights and procedural fairness where eligibility is refused despite credible professional evidence.

Outcome

Eligibility  decisions must be  evidence-based and  safeguard-focused.  Maintaining

professional involvement and avoiding overly narrow functional definitions will reduce delays, prevent deterioration, and support participant trust that the NDIS is making fair and safe access decisions.

Section 8: Automated Decision-Making (Cross-System

Evidence, Overrides, and Safeguards)

Position

If the NDIS expands automated decision-making, it must not do so in a way that reduces procedural fairness, transparency, or safety. Automation can assist with consistency and speed, but it must be paired with strong safeguards, including:

• cross-referencing relevant systems (with consent and lawful authority)
• clear evidence standards that show other avenues have been exhausted
• human override capabilities with defined parameters
• documented reasons and evidence whenever an override occurs Without these protections, automated decisions risk becoming opaque, unchallengeable, and harmful, particularly for participants with complex needs. Key concern: automation without context produces unsafe outcomes

Automated systems are only as reliable as their inputs. If decisions are made using incomplete data, narrow definitions, or siloed information, the result can be:

• inappropriate refusals or reductions of supports
• delays that lead to deterioration and crisis
• inconsistent outcomes across cohorts and regions
• erosion of trust due to lack of explainability Recommendation 1: Cross-system evidence checks (with consent and safeguards)

Where a decision relies on the concept that all other avenues have been exhausted, automated processes should be required to cross-reference relevant systems to confirm what supports are already in place, what has been attempted, and what remains available.

Subject to participant consent, privacy protections, and clear legal authority, this should include cross-referencing (where relevant):

• housing and homelessness services systems
• hospital and community medical records
• My Health Record (where applicable)
• Medicare
• PBS
• NDSS
• other relevant state and Commonwealth systems that materially affect support responsibility and funding pathways

Safeguard link: Cross-referencing must not be used to deny supports by default. It should be used to ensure decisions are evidence-based, responsibilities are correctly allocated, and participants are not bounced between systems. Recommendation 2: Exhaustion and responsibility must be evidenced, not assumed

If a decision outcome depends on whether another system should fund a support, the decision-maker (human or automated) must document:

• what alternative funding pathway was considered
• what evidence supports that pathway being available and appropriate
• whether the participant can realistically access it within a safe timeframe
• what interim supports will prevent deterioration while pathways are pursued Recommendation 3: Human override capability with defined parameters

Automated decision-making must include a human override function that can be triggered by participants, nominees, support coordinators, or authorised parties.

Overrides should be permitted where:

• the automated decision is based on incomplete or incorrect data

• there is a credible risk of harm (health deterioration, safeguarding risk, service collapse)

• the participant has complex needs not captured by standard rules

• there is conflicting evidence across systems that requires clinical judgement Recommendation 4: Mandatory documentation and audit trail for

overrides

Whenever an override occurs, the system must record:

• the reason for the override (mapped to defined parameters)
• the evidence relied upon (documents, reports, cross-system checks)
• the decision-maker identity and role
• the date/time and scope of the override
• the participant-facing explanation in plain language Safeguard link: This creates accountability, supports review rights, and prevents arbitrary or inconsistent manual intervention. Recommendation 5: Explainability, review rights, and participant-facing transparency

Participants must be able to understand and challenge automated decisions. This requires:

• a plain-language explanation of the decision logic and key inputs
• disclosure of what data sources were used (and what was not available)
• clear pathways to request correction of data and seek review
• timeframes that prevent automated delays from becoming service gaps

Outcome

Automation should be used to improve consistency and efficiency, not to reduce rights or shift risk onto participants. Cross-system evidence checks, exhaustion standards, and controlled human overrides with documented evidence are essential safeguards to ensure automated decision-making is fair, safe, and trustworthy.

Section 9: Ministerial Transitional Rule Powers (Structural

Safeguards and Limits)

Position

Transitional rule-making powers must not be used to fundamentally override how the NDIS works in practice or to bypass the Scheme’s core safeguards. While transitional

arrangements can be  necessary  for  implementation,  they must  remain  limited,

transparent, time-bound, and reviewable.

Concerns raised by the Justice and Equity Centre about structural impacts should be treated as a serious warning: broad transitional powers can shift the NDIS away from a rights-based, participant-centred scheme and toward executive discretion with reduced accountability. Key concern: transitional rules can become de facto permanent policy

If transitional rules can alter core operational features (eligibility, planning, review rights, reasonable and necessary decision-making, funding flexibility, or safeguards), then they are not merely transitional. They become a mechanism to change the Scheme without the same scrutiny, consultation, and parliamentary oversight that primary legislation requires.

This creates risks of:

• reduced procedural fairness and inconsistent decision-making
• weakened review rights and transparency
• uncertainty for participants and providers • erosion of trust due to changes being made “by rule” rather than through

accountable legislative process Recommendation: limits and safeguards on transitional rule powers

16. Non-derogation principle

o Transitional rules must not reduce or remove core participant rights,

including review rights, procedural fairness, and access to reasonable and necessary supports.

17. Scope limits (what transitional rules cannot do) o Transitional rules should not be permitted to fundamentally alter: § eligibility thresholds or evidence standards § planning principles and whole person considerations § the reasonable and necessary decision framework § participant choice and control settings § safeguards and complaint pathways § review and appeal mechanisms

18. Time limits and sunset clauses o Transitional rules must be strictly time-bound, with clear sunset dates.

    o Extensions should require parliamentary approval and published

justification.

19. Transparency and reasons o Each transitional rule should include a published statement explaining: § the problem it addresses § why a transitional rule is necessary (rather than standard policy guidance) § expected impacts on participants § how risks will be mitigated

20. Consultation and co-design o Transitional rules should be subject to meaningful consultation with

participants, disability representative organisations, and frontline providers.

21. Independent oversight and reporting o Require independent monitoring of transitional rule impacts, including: § number and type of decisions affected § participant outcomes and complaints § review/appeal volumes and success rates o Publish regular reports during the transition period.

22. Preserve review rights o Participants must retain accessible review pathways for decisions made under transitional rules, including clear written reasons.

Outcome

Transitional powers should support implementation, not restructure the NDIS by executive discretion. Strong limits, transparency, consultation, and oversight are necessary to prevent transitional rules from undermining the Scheme’s design, safeguards, and participant trust.

Other Key Considerations: Unpaid Carers, Paid Family

Care, and Safeguards

Context

Australia already relies on approximately 2.3 million unpaid carers who are indirectly forced into caring for loved ones due to gaps in formal supports. Many carers receive a pension intended to help them manage, but this can reduce their capacity to remain in paid employment and therefore reduces their earning power and taxable income.

This reality should be treated as a structural issue in the NDIS and broader care economy: the system currently depends on unpaid labour while simultaneously increasing the risk of carer burnout and participant instability.

Position

Immediate family members should be given a genuine opportunity to care for their loved one where they are willing and able, and where it is safe and appropriate. Where family members are providing what is effectively full-time disability support work, they should be paid accordingly, including standard employment conditions such as superannuation.

This is not a call to replace the formal workforce with families. It is a call to recognise that, in many cases, family care is already occurring and should be supported, safeguarded, and made sustainable. Recommendation: a regulated pathway for paid family care

Establish a clear pathway that allows immediate family members to be paid as disability support workers when they meet defined criteria.

Eligibility criteria (participant and family member)

•  Demonstrated need  for consistent, trusted supports  (e.g., complex physical

disability, psychosocial complexity, communication barriers, high personal care needs)

• Evidence that family-delivered supports are in the participant’s best interests and align with choice and control

• Confirmation that alternative workforce options are not reasonably available or would create foreseeable risk (e.g., rural/remote shortages, high turnover,

safeguarding concerns)

• The family member is willing, able, and suitable (including screening requirements) Safeguards to prevent burnout and protect participants

If paid family care is permitted, it must be paired with safeguards that protect both the participant and the carer:

23. Mandatory respite and sustainability planning o Funding must include planned respite and backup staffing to prevent carer burnout and service collapse.

24. Minimum capability and training requirements o Family carers must meet baseline training requirements and relevant add ons (e.g., neurological physical disability, complex mental health, forensic, neuropsychological) depending on the participant’s needs.

25. Clear boundaries and rostering rules o Define maximum hours, breaks, and escalation pathways. o Ensure the participant has access to additional supports beyond family care to maintain independence and reduce risk.

26. Quality and safeguarding oversight o Paid family carers should be accountable under a quality and safeguarding framework, including incident reporting and auditability. Accountability: registered provider requirements

Where a family member is being paid to deliver supports, they should be accountable as a registered provider (or under an equivalent regulated arrangement), including:

• compliance with relevant NDIS Practice Standards (scaled to role and risk)
• mandatory incident reporting and complaints pathways
• record-keeping and audit requirements
• clear conflict-of-interest management

Outcome

A regulated paid-family-care pathway would:

• reduce hidden reliance on unpaid labour
• improve continuity and stability of supports where workforce access is limited
• reduce burnout risk through funded respite and sustainability planning
• strengthen accountability and safeguarding through registration and oversight
• better align economic reality with participant safety and choice

Other Considerations: Skilled Workforce

Position

A safe, stable, and professional disability workforce requires two foundational settings:

• every person working in the disability sector must be appropriately qualified for the supports they deliver, and

• every worker must be registered, including those who are sole traders. This should be paired with reform of workforce settings that unintentionally weaken retention and accountability, including the current approach to portable long service leave schemes governed by state governments.

1. Mandatory qualifications for all disability workers The NDIS should require that all workers delivering disability supports meet nationally consistent minimum qualifications and role-based competencies.

This is a safeguarding measure. It reduces preventable harm and improves participant trust by ensuring workers have verified capability, not just experience.

Recommendation

• Require baseline qualifications for all workers (aligned to the national framework proposed earlier), with specialty streams and add-ons for complex cohorts.

• Prohibit deployment into higher-risk supports unless the worker has the relevant verified competencies.

2. Mandatory registration for all workers (including sole traders) If workers are not registered, accountability becomes inconsistent and participants cannot easily verify suitability, training, or compliance history.

Recommendation

• Require every worker providing NDIS-funded disability supports to be registered, regardless of employment type.

• This must include sole traders and independent contractors.

• Registration should include: o identity and screening checks o minimum training verification o ongoing CPD requirements (scaled to role and risk) o clear complaint pathways and enforceable conduct standards

3. Portable long service leave: reform to support loyalty and stability Portable long service leave schemes can create unintended incentives that weaken workforce stability. Under current arrangements, disability support workers can move between employers (or be terminated) while entitlements remain portable, and providers may still be required to pay a levy to the state government to be held in trust.

This can reduce the incentive for long-term commitment to a single employer and may widen the gap where a worker can disengage from challenging participants without any impact on long-term entitlements.

Recommendation

• Remove or fundamentally reform portable long service leave arrangements for the disability sector where they: o impose ongoing levy costs on providers regardless of retention outcomes, and o do not promote loyalty, continuity of care, or workforce stability. Safeguarding and participant outcomes

Workforce qualification and registration requirements, combined with retention settings that promote continuity, will:

• reduce incidents and complaints
• improve consistency of care and participant safety
• strengthen professional standards across the sector
• rebuild participant trust that the workforce is competent and accountable

Outcome

A skilled workforce is not achieved through policy intent alone. It requires enforceable minimum qualifications, universal registration (including sole traders), and workforce settings that incentivize stability and continuity rather than enabling churn.

Recommendation

Purpose

This recommendation calls for a nationally consistent, independent, and rights-based approach to address abuse, neglect, exploitation, and systemic navigation failures experienced by people living with disability. It focuses on rebuilding trust, closing gaps between the healthcare system and the NDIS, and embedding supported decision-making so people can access safe, coordinated, and person-led supports. Problem statement

People living with disability have reported being:

• Taken advantage of financially and socially
• Abused and neglected in services and informal support settings
• Left without clear pathways to raise concerns or change providers
• Unable to navigate complex systems, eligibility rules, and service boundaries • Harmed by disparities between healthcare and the NDIS, including unclear

responsibility for “who funds what” and “who coordinates what”

These experiences erode trust, reduce service engagement, and contribute to poorer health and wellbeing outcomes.

Recommendation (core proposal)

Establish a National Independent Disability Navigation and Supported Decision-

Making  Service (NIDNSDMS), funded by  the  Federal Government and  delivered

independently of providers, with a clear mandate to:

27. Prevent and respond  to  exploitation, abuse, and  neglect through  early

identification, escalation pathways, and warm referrals.

28. Rebuild trust by providing consistent, impartial guidance and advocacy-like navigation that is not tied to service provision.

    29. Bridge the healthcare–NDIS divide by coordinating information and

responsibilities across systems.

30. Embed supported decision-making as a default, with safeguards, so people can make informed choices about supports, health care, and life decisions. Key features

1. Independent and conflict-free • Operate independently from NDIS providers, plan managers, and support

coordination businesses.

• Clear governance, transparency, and conflict-of-interest rules.

2. Single front door with local presence

• A national hotline, online portal, and face-to-face outreach options.
• Accessible service design (Easy Read, Auslan, interpreter access, culturally safe supports, and trauma-informed practice).

3. Supported decision-making framework

• Offer supported decision-making facilitators trained in rights-based practice. • Provide practical tools for consent, choice, and control (decision aids,

communication supports, and meeting support).

•  Ensure  safeguards  for  people  at  risk  of  coercion,  including pathways  to

independent advocacy and protective responses.

4. Whole-of-person coordination across stakeholders

• With the person’s consent, support shared understanding across stakeholders (family, carers, clinicians, allied health, support workers, hospitals, NDIS partners).

• Produce a clear, person-led “totality of needs” summary that aligns: o Health needs and clinical risks o Functional supports and daily living needs o Psychosocial and community participation goals o Safety concerns and safeguarding actions

o Roles and responsibilities across systems

5. Clear escalation and safeguarding pathways

• Standardised pathways for reporting and escalation to appropriate bodies.
• Proactive check-ins for high-risk situations (e.g., recent discharge, provider change, domestic violence risk, unstable housing).

6. System accountability and learning

• De-identified trend reporting to government on: o Common abuse/exploitation patterns o Service gaps and navigation failures o Disputes between health and NDIS responsibilities o Regional access inequities

• Use insights to inform policy reform, workforce standards, and commissioning. Implementation actions

31. Legislate and fund the independent service with national coverage and minimum service standards.

    32. Co-design with people living with disability, including those with complex

communication needs, cognitive disability, and psychosocial disability.

33. Integrate with hospitals, primary care, and community health services via referral pathways and shared protocols.

34. Workforce development: training in supported decision-making, trauma-informed care, safeguarding, and cultural safety.

35. Data and quality framework: define outcomes, service benchmarks, and reporting requirements. Expected outcomes

• Reduced incidence and duration of abuse, neglect, and exploitation through earlier detection and clearer pathways.

• Improved trust in systems due to independent, consistent guidance. • Better continuity of care and reduced “handover harm” between hospitals,

community health, and NDIS supports.

• Increased participant autonomy and informed choice through supported decision- making.

• Improved health and wellbeing outcomes through coordinated, whole-of-person planning. Suggested measures of success

• Time from first contact to resolution/referral

• Participant-reported trust and safety scores

• Reduction in repeat crises (e.g., avoidable hospital presentations linked to support failure)

• Improved service continuity post-hospital discharge

• Increased uptake and documented use of supported decision-making tools

• Reduction in complaints linked to navigation confusion and provider misconduct Closing statement

People living with disability deserve safe supports, clear pathways, and systems that work together. An independent navigation and supported decision-making service would rebuild trust, reduce harm, and ensure all stakeholders understand the person’s total needs— leading to better outcomes for health, wellbeing, and genuine choice and control.

Proposal to Reduce Fraud in the NDIS

Purpose

This proposal recommends a practical, enforceable framework to reduce fraud and misuse in the NDIS by strengthening workforce requirements, standardising claim

generation, and requiring auditable evidence that services were delivered. It also ensures consistent safeguards and rules for participants regardless of funding management type (agency-managed, plan-managed, or self-managed). Problem statement

Fraud and misuse in the NDIS is enabled by:

• Inconsistent workforce standards and variable competency across roles

• Confusion and overlap in role definitions (e.g., psychology vs psychosocial supports, recovery coaching vs support coordination)

• Claims being raised without consistent documentation or verifiable proof of service delivery

• Weak travel evidence requirements

• Uneven participant protections depending on whether a plan is agency-managed, plan-managed, or self-managed Policy objectives

• Reduce fraudulent and inflated claims while preserving participant choice and control

• Improve quality and safety through minimum workforce standards

• Create a consistent, auditable evidence trail for service delivery

• Apply equivalent safeguards across all plan management types Recommendation 1: Mandatory minimum qualifications and role-based credentialing 1.1 Introduce a mandatory baseline qualification for all disability-sector workers

Require a minimum nationally recognised qualification for anyone delivering NDIS-funded supports, including:

• Support workers

• Support coordinators

• Psychosocial recovery coaches

• Allied health (where applicable to their profession) Implementation concept:

• A minimum Certificate-level qualification for direct support roles, plus mandatory induction modules (NDIS Code of Conduct, safeguarding, restrictive practices awareness, incident reporting, privacy, and supported decision-making).

• Role-specific credentialing for specialist roles (see below).

1.2 Role clarity and protected titles

Create clear, enforceable distinctions and protected titles to reduce misrepresentation and incorrect billing.

Must clearly distinguish between:

• Psychology (registered psychologist / endorsed psychologist where relevant, billed only when delivered by appropriately registered professionals)

  • PBS (Positive Behaviour Support) (delivered by appropriately qualified

practitioners operating within relevant frameworks and reporting requirements)

• Psychosocial Recovery Coach (scope limited to psychosocial disability coaching functions, not substituted for clinical therapy or support coordination)

• Support Coordinator (coordination and capacity-building functions, not direct support delivery unless explicitly allowed and conflict-managed)

Proposed mechanism:

• National role definitions aligned to NDIS line items and registration categories.
• A public register of credentials and scope of practice.
• Stronger penalties for claiming outside scope. Recommendation 2: Claims must be generated from approved

accounting / claiming systems 2.1 Mandatory use of approved systems

Require all providers and intermediaries (including plan managers) to generate claims from an approved accounting/claiming system that supports:

• Standardised invoice formats
• Immutable audit logs (who created/edited claims and when)
• Attachment of evidence (service notes, attendance confirmation, travel logs)
• Automated anomaly detection flags (duplicate claims, unusually high frequency, out-of-hours patterns) 2.2 Standardised data fields

Mandate minimum claim fields across the scheme:

• Participant identifier
• Worker/provider identifier
• Service type and line item
• Date, start/end time, duration
• Location (service address or agreed community location)

• Delivery mode (in-person / telehealth)
• Travel claimed (if applicable) with kilometres and route summary Recommendation 3: Evidence-of-service requirements for all claims 3.1 Mandatory evidence that services were provided

Require every claim to include clear evidence of service delivery, proportionate to risk and service type.

Minimum evidence requirements:

• A brief service note (what was delivered, aligned to goals)

• Geo-referencing data (location confirmation at time of service, with privacy safeguards)

• Participant signature or confirmation by one of the following: o Participant o Family member who lives with the participant o Plan nominee

Safeguards:

• Where a participant cannot sign, allow accessible confirmation methods (verbal confirmation recorded, communication aid confirmation, or nominee confirmation).

• Ensure consent and privacy controls are explicit and auditable. 3.2 Risk-based auditing

Apply higher evidence thresholds and more frequent audits for:

• High-volume providers
• Providers with prior compliance issues
• High-risk line items (e.g., high travel, high intensity supports)
• Rapid claim spikes or unusual billing patterns Recommendation 4: Travel claims require logbook evidence 4.1 Mandatory travel logbooks

If provider travel is claimed, require evidence by way of a logbook that includes:

• Date and time of travel
• Start and end locations
• Purpose (linked to participant and service)
• Kilometres travelled
• Route summary (or mapping export where available)

4.2 Consistency and reasonableness rules

• Cap or benchmark travel claims by region type (metro, regional, remote) with clear exceptions process.

• Require travel to be claimed only where it is compliant with pricing arrangements and explicitly linked to service delivery. Recommendation 5: Equal rules and safeguards for all plan management types 5.1 Consistent participant protections

Participants should have the same rules and protections whether they are:

• Agency-managed

• Plan-managed

• Self-managed This includes:

• Evidence-of-service requirements

• Travel evidence requirements

• Role/credential checks

• Audit exposure (risk-based) 5.2 Support for self-managed participants

To avoid creating barriers for self-managed participants, provide:

• Free access to an approved claiming tool (or a simplified portal)
• Templates for service agreements, service notes, and travel logs
• Education on spotting fraud and understanding invoices Implementation plan (high-level)

36. Co-design and consultation with people with disability, providers, plan managers, allied health peak bodies, and safeguarding experts.

37. Legislate minimum standards for qualifications, protected titles, and evidence requirements.

38. Accredit approved systems and set a transition period for providers to migrate.

39. Pilot and stage rollout (start with high-risk line items and high-volume providers).

40. Compliance and enforcement: penalties for non-compliance, plus support and training for providers to meet requirements.

Expected outcomes

•  Reduced  fraudulent and  inflated  claims  through  stronger  verification and

auditability

• Improved service quality via minimum qualifications and clearer role boundaries

• Better participant confidence and transparency through consistent rules

• More effective compliance activity via risk-based auditing and standardised claim data Measures of success

• Reduction in confirmed fraud cases and overpayment recovery volumes over time

• Increased detection of anomalies earlier (shorter time-to-detection)

• Improved participant-reported confidence in billing integrity

• Higher compliance rates with evidence attachments and travel logbooks

• Reduced complaints related to misrepresentation of roles and services