Submission 614 - Supplementary Submission
I make this submission as an experienced NDIS Support Coordinator who has worked extensively with participants experiencing complex psychosocial disability, intellectual disability, acquired brain injury and multiple co-existing conditions. My submission is informed by frontline experience assisting participants to navigate the Scheme and by direct experience supporting participants through reviews, evidence gathering and correction of inaccurate Agency records.
I acknowledge the Government’s objective of improving the long-term sustainability of the National Disability Insurance Scheme. However, I am concerned that many of the amendments proposed simply reiterate legislative standards that are already there and provide no mechanism to enforce these standards in practise .
The areas that I have highlighted for further discussion are;
- Schedule 2—Fraud measures
- Proposed Amendments to Permanency and the Link Between Impairment and
Supports
I have also included a section outlining the current pressure on the system and the substantial cost to the tax payer and families caused by the inconsistencies between the current legislation and its practical application when issuing outcomes to participants and their families .
Schedule 2—Fraud measures
While Schedule 2 strengthens the NDIA’s regulatory and investigative powers, it does not address many of the operational issues that are currently contributing to fraud, poor provider practices and risks to participants.
The Bill primarily expands the NDIA’s ability to investigate, request information and regulate a broader range of providers after concerns have arisen. However, it does not introduce practical measures to prevent poor providers from entering or continuing to operate within the Scheme in the first place.
The current problems are not simply the result of insufficient legislative powers. Rather, they arise from inconsistent implementation, limited enforcement of existing obligations and the absence of consistent minimum requirements across all providers.
For example, the Bill does not require all providers to demonstrate minimum competency, relevant qualifications, appropriate insurance, governance systems or compliant record keeping before accessing NDIS funding. Nor does it establish a consistent national
Submission 614 - Supplementary Submission
requirement for providers to maintain and produce basic documentation, despite this being fundamental to participant safeguarding and financial accountability.
Similarly, while the amendments introduce civil penalties for failing to comply with a notice requiring information or documents, they do not address the situation where providers have never created or maintained the required documentation in the first place. A provider cannot produce records that do not exist, yet inadequate record-keeping remains a recurring concern raised by participants, families and support coordinators.
The proposed measures also fail to address inconsistencies in identity verification. Individuals seeking access to government systems such as the Provider Portal are required to complete extensive identity verification processes, while equivalent verification is not consistently required before claims are submitted and public funds are paid. This inconsistency represents a missed opportunity to strengthen fraud prevention at the point where payments are made.
Importantly, the Bill does not establish a proactive compliance framework that routinely verifies providers are meeting existing obligations before significant public funds are expended. Instead, the amendments remain largely reactive, providing additional enforcement tools once concerns have already been identified.
A more effective approach would focus on prevention as well as enforcement. This could include mandatory minimum entry standards for all providers, consistent identity verification linked to payment systems, routine auditing of documentation and governance requirements, timely investigation of complaints, and meaningful enforcement where providers repeatedly fail to meet established standards.
Without addressing these underlying operational deficiencies, the proposed amendments risk increasing regulatory powers without resolving the practical issues that continue to undermine participant safety, Scheme integrity and public confidence. The focus should be on ensuring that existing and proposed obligations are applied consistently across the Scheme and enforced in a timely and proportionate manner.
Proposed Alternative
Minimum Entry Requirements for Unregistered Providers
The proposed amendments recognise the importance of protecting the financial sustainability and integrity of the NDIS. However, many of the issues the Bill seeks to address are already covered by existing legislation and regulatory powers. The more pressing concern is the inconsistent application and enforcement of these existing safeguards.
Rather than introducing additional legislative powers, greater improvements could be achieved by implementing consistent, practical and enforceable requirements across all areas of the Scheme.
Submission 614 - Supplementary Submission
The following measures are recommended:
-
Consistently enforce the compliance and investigative powers already available to the NDIA and the NDIS Quality and Safeguards Commission.
-
Introduce minimum national entry requirements for all providers accessing NDIS funding, regardless of registration status, including verified identity, appropriate insurance, relevant qualifications or demonstrated competency where applicable, and basic governance requirements.
-
Require all providers to maintain mandatory documentation, including service agreements, case notes, progress records, staff rosters where relevant, invoices and evidence that supports have been delivered.
-
Increase auditing and compliance activities focusing on providers who repeatedly fail to meet documentation, governance and record-keeping obligations.
-
Introduce consistent identity verification requirements before payment claims are processed, ensuring that those receiving public funds are subject to the same level of verification required to access NDIS administrative systems.
-
Strengthen enforcement against providers who fail to meet minimum documentation and safeguarding standards, rather than allowing ongoing non-compliance to continue unchecked.
-
Improve information sharing and intelligence-led compliance activities to identify organised fraud while reducing unnecessary administrative burdens on participants and compliant providers.
-
Ensure participants are not disadvantaged during plan reviews, reassessments or appeals because providers have failed to maintain records that they were required to keep.
-
Apply compliance requirements consistently across registered and unregistered providers where they are delivering the same supports using public funding.
Fraud prevention should focus on strengthening operational controls, improving regulatory oversight and ensuring consistent enforcement of existing obligations. Protecting the integrity of the NDIS is not simply a matter of creating additional legislative powers; it requires those powers to be applied effectively, proportionately and consistently.
A Scheme that applies clear, uniform standards to all providers, enforces existing obligations and prioritises accountability will better protect participants, safeguard public funds and strengthen public confidence in the NDIS. At the same time, these measures
Submission 614 - Supplementary Submission
should preserve participant choice and control by ensuring that compliance requirements are proportionate to the risks involved and do not create unnecessary barriers for participants or high-quality providers.
Proposed Amendments to Permanency and the Link Between
Impairment and Supports
The Bill proposes several significant changes to the access criteria for the NDIS, including:
-
introducing a statutory definition of functional capacity as the basis for determining eligibility;
-
strengthening the requirement that funded supports must arise directly from an impairment for which the person met the NDIS access criteria;
-
tightening the definition of permanence, requiring that all appropriate treatment to remedy or alleviate an impairment has been undertaken, that no further appropriate treatment is likely to materially improve the impact of the impairment, and that the impairment is likely to be lifelong; and
-
introducing a more standardised and evidence-based assessment process for determining functional capacity.
Proposed Alternatives
Permanency Should Reflect the Nature of Different Disabilities
The current legislation, together with the proposed amendments, continues to create uncertainty regarding the concepts of permanency, impairment and functional capacity. Rather than simplifying the access process, the proposed changes risk introducing further complexity for applicants, participants and decision-makers.
Not all disabilities present in the same way. Some conditions, by their very nature, clearly indicate permanence. Conditions such as intellectual disability, many genetic disorders, cerebral palsy, acquired brain injury, spinal cord injury and other lifelong neurological conditions are generally accepted as permanent and are unlikely to improve to the extent that disability-related support is no longer required. Requiring individuals with these conditions to repeatedly demonstrate permanency provides little additional value and creates unnecessary administrative burden.
Submission 614 - Supplementary Submission
Conversely, other disabilities, particularly psychosocial disabilities and some neurological or degenerative conditions, may fluctuate over time. While symptoms may vary, the underlying impairment may still be permanent and continue to result in substantial functional impairment. Variability in presentation should not be interpreted as evidence that a disability is temporary or that support needs are no longer present. For these participants, eligibility should be assessed by considering the ongoing impact of the condition on functional capacity over time rather than isolated periods of improvement or deterioration.
The current legislative framework, together with the proposed amendments, does not clearly distinguish between these different categories of disability. Instead, it risks conflating permanence of diagnosis with fluctuations in functional presentation, creating uncertainty for participants and inconsistent decision-making across the Scheme.
There are participants with little to no functional impairment who have access to daily supports and refuse to engage with health professionals, counsellors or programs and continue to receive these supports while there are participants with significant permanent impairments who have no access to basic supports needed to function each day , ie; showering , transport, assistance with meal preparation.
How is this possible?
A more practical and equitable approach would recognise that permanence should be assessed according to the nature of the disability.
Where a condition is clinically recognised as lifelong or irreversible, permanency should generally be accepted without repeated reassessment.
For conditions that are variable in presentation, the focus should be on the enduring impact of the impairment on functional capacity rather than the day-to-day fluctuation of symptoms.
The supports provided should remain focussed on addressing the areas needing support and making these supports mandatory to continued access to the scheme ;
Eg’ mandatory counselling and therapy to assist with psychosocial conditions , participation in group programs , rehab programs. Refusal to engage with meaningful supports should restrict access to the scheme especially in the instance where the impairments suffered as a result of this refusal are the reason they are seeking access.
Adopting this approach would simplify access to the NDIS, reduce unnecessary requests for duplicate medical evidence, improve consistency in decision-making and allow the NDIA to focus its resources on assessing functional support needs rather than repeatedly determining whether an already established permanent disability remains permanent. This would better align the Scheme with its objective of supporting people whose disabilities result in significant and enduring functional impairment while reducing unnecessary complexity for participants and decision-makers alike.
Submission 614 - Supplementary Submission
This will also allow for genuine reduction in fraudulent access to supports that have no therapeutic benefit nor provide supports that could not be accessed independently.
Substantial increases in legal costs
The proposed emphasis on financial sustainability in section 17B appears to assume that more prescriptive decision-making will improve the efficiency of the Scheme. However, current evidence suggests that disputed decisions already impose a substantial administrative and financial burden on both participants and the NDIA. Parliamentary reporting indicates that applications to the Administrative Review Tribunal increased by approximately 76%, from 4,043 applications in 2023–24 to 7,132 applications in 2024–25, while almost 30,000 active NDIS matters were before the Tribunal, the majority relating to planning and funding decisions rather than eligibility. Importantly, more than 96% of finalised NDIS matters were resolved before a final hearing, indicating that a significant proportion of disputes are settled only after considerable expenditure of Agency resources, participant time and professional involvement.
These statistics suggest that the principal issue may not be the legislative framework itself, but the quality and consistency of initial decision-making. Where participants are required to obtain updated occupational therapy assessments, functional capacity assessments, specialist medical reports, psychological assessments and other expert evidence to challenge decisions, the financial burden extends well beyond the Tribunal process itself. It also encompasses the costs of allied health professionals, support coordinators, disability advocates, legal representatives and NDIA legal resources. Recent reporting indicates that the NDIA’s expenditure on external legal services has increased substantially in parallel with the growing number of appeals.
In this context, there is a real risk that placing greater legislative emphasis on financial sustainability, while simultaneously narrowing decision-making discretion and increasing evidentiary thresholds, may have the unintended consequence of generating more internal reviews, more external review applications and greater overall administrative expenditure. A more sustainable approach would be to improve the accuracy of initial decisions, ensure participant records are current and complete, and strengthen the quality of planning processes before introducing legislative principles that may encourage more restrictive funding decisions.
I have several participants who have agreed to present their experiences as evidence , however I would like to highlight one in particular in reference to the above
- adult male participant aged 42 with lifelong Intellectual delay , epilepsy and autism .
Submission 614 - Supplementary Submission
-
His information and diagnosis was entered incorrectly as “Autistic “when he entered the scheme by a representative of Uniting care , appointed as LAC by the NDIS.
-
The participant has ageing parents who , until they attempted to get permanent long term supports in place for their son , were not made aware of this error at any time .
-
Despite the NDIA holding extensive evidence dating back to 1992 , numerous reports , and no evidence to support the incorrect diagnosis, it has taken over 3 years , 4 ministerial complaints, several applications and now a tribunal hearing to determine that the participant required a full reassessment of his plan under section 48.
-
This was requested in 2023 . This should not be happening , The current process requires families to obtain multiple specialist reports, functional capacity assessments, psychological assessments and medical evidence at significant financial and emotional cost, despite there being no equivalent obligation on the NDIA to demonstrate that its decisions are based on current, complete and accurate participant information.
The burden of proof has therefore fallen disproportionately on participants and their informal supports, many of whom are already managing complex disability, caring responsibilities and financial pressures. For families, the review process has become one of repeatedly justifying needs that have not materially changed, rather than focusing on achieving the participant’s goals and improving quality of life. This has contributed to advocacy fatigue, delayed access to essential supports, deterioration in participant wellbeing while decisions are contested, and a growing loss of trust in the Scheme. A genuinely sustainable NDIS should require accountability on both sides: participants should provide reasonable evidence to support their needs, but the NDIA should also be required to ensure that decisions are made using accurate, up-to-date information and to justify any departure from the weight of available professional evidence. Without a more balanced approach, the proposed amendments risk perpetuating a system in which the burden of proving disability rests almost exclusively with those least equipped to bear it.
Conclusion
The National Disability Insurance Scheme has transformed the lives of hundreds of thousands of Australians by recognising that disability support must be individualised, evidence-based and centred on each person’s goals, capacity and aspirations. I acknowledge and support the Government’s responsibility to ensure the Scheme remains financially sustainable for future generations. However, sustainability should not be achieved by increasing barriers to access, reducing individualised decision-making or shifting a disproportionate evidentiary burden onto participants and their families.
Throughout my experience as an NDIS Support Coordinator, I have observed that many disputes do not arise because participants are seeking unreasonable supports, but because
Submission 614 - Supplementary Submission
decisions are frequently based on incomplete, outdated or inaccurate information, inconsistent interpretation of evidence, and administrative processes that fail to adequately consider the participant’s unique circumstances. These systemic issues contribute to increasing numbers of internal reviews and applications to the Administrative Review Tribunal, generating significant costs for participants, families, allied health professionals, advocates, legal representatives and the NDIA itself.
The proposed amendments, particularly those introducing broader sustainability principles, more prescriptive funding categories and greater reliance on delegated legislation, risk further reducing flexibility within a Scheme that was intentionally designed to recognise that no two participants experience disability in the same way. Individual capacity cannot be measured solely against standardised criteria or actuarial considerations. Genuine equity is achieved by recognising differences in need, not by treating participants with superficially similar circumstances as though their support requirements are identical.
I respectfully submit that the long-term sustainability of the NDIS will be better achieved through improving the quality and consistency of decision-making, ensuring participant records are accurate and current, strengthening accountability across the Scheme, and investing in early, evidence-based planning that reduces the need for costly review and appeal processes. A Scheme that makes better decisions at the outset is inherently more sustainable than one that relies on participants to correct those decisions through repeated reviews and litigation.
I therefore respectfully request that the Committee carefully consider the concerns raised in this submission and the potential unintended consequences of the proposed amendments for participants, families and the broader disability sector.
I would also welcome the opportunity to appear before the Senate Community Affairs Legislation Committee to provide evidence in person. As a practising Support Coordinator working directly with participants navigating the NDIS, I believe I can offer practical, frontline insight into how the proposed amendments may operate in practice, identify unintended consequences not readily apparent from the legislation alone, and contribute constructive recommendations that support both participant outcomes and the long-term sustainability of the Scheme. I would be pleased to answer questions from the Committee and provide de identified case examples that illustrate the practical implications of the proposed reforms.