Impact of CBDA budget reductions on allied health therapy access (Provider advocacy)

Submission 660

​Submission​​regarding​​practical​​impacts​​of​​the​​National​​Disability​ ​Insurance​​Scheme​​Amendment​​(Securing​​the​​NDIS​​for​​Future​ ​Generations)​​Bill​​2026​​on​​a​​regional​​allied​​health​​practice​

​Senate​​Inquiry​​Submission​

​Submitted​​by:​​Active​​Health​​Riverina​ ​Services:​​Physiotherapy,​​Paediatric​​Physiotherapy,​​Exercise​​Physiology,​​Podiatry,​​Therapy​ ​Assistants,​​Group​​Classes​ ​Locations:​​Lewisham​​Avenue​​Wagga​​Wagga,​​Dobney​​Avenue​​Wagga​​Wagga,​​Coolamon​

​NSW​

​Client​​group:​​Mixed​​paediatric​​and​​adult​ ​NDIS​​status:​​Unregistered​​provider​ ​In​​operation:​​Over​​25​​years​​serving​​the​​Riverina​​community​ ​Date:​​May​​2026​ ​Website:​​www.activehealthriverina.com.au​

​About​​Active​​Health​​Riverina​ ​Active​​Health​​Riverina​​is​​a​​locally​​owned​​allied​​health​​practice​​that​​has​​been​​serving​​the​ ​Riverina​​community​​for​​over​​25​​years.​​We​​operate​​across​​three​​clinic​​locations:​​Lewisham​ ​Avenue​​and​​Dobney​​Avenue​​in​​Wagga​​Wagga,​​and​​a​​third​​clinic​​in​​Coolamon,​​a​​rural​ ​community​​approximately​​45​​kilometres​​from​​Wagga​​Wagga.​​Our​​multidisciplinary​​team​ ​delivers​​physiotherapy,​​paediatric​​physiotherapy,​​exercise​​physiology,​​podiatry,​​group​ ​classes​​and​​therapy​​assistant​​services​​to​​children​​and​​adults​​across​​the​​region.​ ​Approximately​​20​​per​​cent​​of​​our​​current​​caseload​​is​​NDIS-funded.​​We​​are​​an​​unregistered​ ​provider.​​We​​work​​closely​​with​​participants,​​families,​​support​​coordinators​​and​​plan​ ​managers​​to​​ensure​​therapy​​is​​goal-focused​​and​​aligned​​with​​each​​individual’s​​plan.​​Our​ ​NDIS​​participants​​include​​children​​with​​developmental​​delay,​​autism​​and​ ​neurodevelopmental​​conditions,​​as​​well​​as​​adults​​with​​acquired​​brain​​injuries,​​progressive​ ​neurological​​conditions,​​chronic​​conditions​​and​​complex​​disability.​ ​Wagga​​Wagga​​is​​the​​major​​regional​​hub​​for​​the​​Riverina​​and​​Murray​​regions.​​Many​​of​​our​ ​clients​​travel​​significant​​distances​​to​​access​​services​​that​​are​​not​​available​​closer​​to​​home.​ ​Our​​Coolamon​​clinic​​was​​established​​specifically​​to​​reduce​​the​​travel​​burden​​on​​families​​in​ ​surrounding​​rural​​communities.​​For​​many​​of​​these​​families,​​we​​are​​not​​one​​of​​several​ ​options.​​We​​are​​the​​option.​ ​We​​are​​making​​this​​submission​​because​​the​​reforms​​in​​this​​Bill,​​together​​with​​decisions​ ​already​​being​​made​​about​​how​​Thriving​​Kids​​will​​be​​delivered​​in​​NSW,​​will​​have​​serious​​and​ ​compounding​​consequences​​for​​regional​​families,​​children​​and​​practices​​like​​ours.​​We​​are​ ​not​​arguing​​against​​reform.​​We​​are​​asking​​the​​Committee​​to​​look​​carefully​​at​​how​​these​ ​changes​​will​​land​​in​​communities​​where​​the​​margin​​for​​disruption​​is​​much​​smaller​​than​​it​​is​​in​ ​metropolitan​​areas.​

Submission 660

​1.​​Schedule​​1:​​CBDA​​Budget​​Reductions​​(10%​​from​​1​​October​​2026)​

​Concern​ ​Capacity​​Building​​Daily​​Activities​​(CBDA)​​is​​the​​primary​​funding​​line​​through​​which​​our​​NDIS​ ​participants​​access​​physiotherapy,​​exercise​​physiology​​and​​podiatry.​​A​​mandated​​10​​per​ ​cent​​reduction​​to​​these​​budgets,​​phasing​​from​​October​​2026​​as​​plans​​are​​reviewed,​​will​ ​directly​​reduce​​the​​number​​of​​therapy​​sessions​​our​​clients​​can​​access.​ ​The​​Impact​​Analysis​​supporting​​the​​Bill​​argues​​that​​the​​published​​evidence​​for​​high-volume​ ​long-term​​therapy​​is​​thin.​​We​​acknowledge​​that​​evidence​​standards​​matter.​​But​​this​​framing,​ ​applied​​broadly,​​obscures​​the​​clinical​​reality​​of​​what​​we​​deliver.​​Paediatric​​physiotherapy​​for​ ​a​​child​​with​​cerebral​​palsy​​or​​developmental​​delay​​is​​not​​optional.​​Exercise​​physiology​​for​​an​ ​adult​​with​​an​​acquired​​brain​​injury​​builds​​the​​physical​​capacity​​that​​underpins​​every​​other​ ​goal​​in​​their​​plan.​​Podiatry​​for​​a​​participant​​with​​neuropathy,​​diabetes​​or​​significant​​gait​ ​impairment​​is​​preventive​​care​​that​​reduces​​far​​more​​costly​​health​​events​​down​​the​​track.​ ​These​​are​​not​​high​​volumes​​of​​discretionary​​therapy.​​They​​are​​the​​baseline​​of​​what​​these​ ​participants​​need​​to​​maintain​​function,​​participate​​in​​their​​communities​​and​​avoid​​more​ ​intensive​​support​​later.​​A​​10​​per​​cent​​reduction​​in​​that​​context​​does​​not​​mean​​slightly​​less​​of​ ​something​​optional.​​For​​families​​already​​carefully​​rationing​​their​​plan​​budgets,​​it​​means​ ​choosing​​which​​appointment​​to​​cancel.​

​Likely​​real-world​​impact​ ​•​ ​Participants​​will​​have​​fewer​​funded​​sessions​​available​​and​​will​​face​​real​​choices​ ​about​​which​​services​​to​​reduce​​or​​stop​ ​•​ ​For​​children​​receiving​​paediatric​​physiotherapy​​through​​NDIS,​​reduced​​hours​​narrow​ ​the​​developmental​​window​​during​​which​​early​​intervention​​produces​​its​​greatest​ ​gains​ ​•​ ​Adults​​with​​complex​​or​​progressive​​conditions​​may​​experience​​functional​​decline​ ​without​​adequate​​maintenance​​therapy,​​increasing​​dependence​​on​​higher-cost​ ​supports​​later​ ​•​ ​This​​cut​​falls​​on​​top​​of​​the​​travel​​claiming​​reduction​​already​​in​​effect​​since​​1​​July​ ​2025,​​which​​halved​​our​​billable​​travel​​rate​​and​​has​​already​​compressed​​the​​viability​ ​of​​outreach​​services​​to​​clients​​in​​Coolamon​​and​​surrounding​​communities​ ​•​ ​The​​cumulative​​financial​​pressure​​on​​both​​the​​funding​​available​​to​​clients​​and​​the​ ​revenue​​available​​to​​providers​​makes​​NDIS​​work​​progressively​​less​​viable​​for​​small​ ​regional​​practices​​like​​ours​

​2.​​Schedule​​3:​​Differentiated​​Pricing​​for​​Unregistered​​Providers​

​Concern​ ​Approximately​​90​​per​​cent​​of​​allied​​health​​therapy​​providers​​nationally​​are​​NDIS​ ​unregistered.​​Active​​Health​​Riverina​​is​​among​​them.​​We​​chose​​this​​model​​for​​practical​ ​reasons.​​The​​audit,​​compliance​​and​​administrative​​requirements​​of​​registration​​are​ ​substantial​​for​​a​​small​​regional​​practice​​without​​dedicated​​compliance​​or​​administrative​ ​support.​​Our​​clinical​​standards,​​documentation​​and​​professional​​obligations​​are​​not​​different​ ​because​​we​​are​​unregistered.​​Our​​outcomes​​are​​not​​different.​​Our​​accountability​​to​​our​ ​clients​​is​​not​​different.​ ​The​​Bill​​enables​​the​​Minister​​to​​set​​separate​​price​​limits​​for​​unregistered​​providers​​across​​a​ ​wide​​range​​of​​dimensions,​​including​​registration​​status,​​region,​​delivery​​mode​​and​​session​ ​type.​​The​​concern​​is​​not​​with​​differentiated​​pricing​​as​​a​​concept.​​The​​concern​​is​​with​ ​applying​​a​​nationally​​consistent​​policy​​to​​structurally​​different​​markets.​​What​​this​​looks​​like​​in​

Submission 660

​Sydney,​​where​​registered​​alternatives​​exist​​within​​a​​short​​distance​​of​​almost​​every​ ​participant,​​is​​not​​what​​it​​looks​​like​​in​​Wagga​​Wagga​​or​​Coolamon.​

​Likely​​real-world​​impact​ ​•​ ​If​​unregistered​​providers​​are​​set​​lower​​price​​limits,​​participants​​choosing​​us​​will​​face​​a​ ​choice​​between​​paying​​a​​gap​​fee​​out​​of​​pocket,​​finding​​a​​registered​​alternative,​​or​ ​going​​without​ ​•​ ​The​​pool​​of​​NDIS-registered​​allied​​health​​providers​​in​​Wagga​​Wagga​​is​​small.​​In​ ​Coolamon​​and​​surrounding​​rural​​communities,​​it​​is​​effectively​​non-existent​ ​•​ ​Practices​​like​​ours​​face​​a​​forced​​choice:​​absorb​​a​​lower​​rate​​that​​does​​not​​cover​​the​ ​cost​​of​​delivering​​the​​service,​​pursue​​costly​​and​​time-consuming​​registration,​​or​ ​reduce​​NDIS​​intake​ ​•​ ​If​​small​​regional​​unregistered​​providers​​reduce​​NDIS​​work​​or​​exit​​the​​market,​ ​participants​​do​​not​​move​​to​​a​​registered​​alternative.​​They​​lose​​access​​entirely​ ​•​ ​The​​implementation​​timeline​​remains​​unclear.​​Consultation​​is​​not​​scheduled​​to​ ​conclude​​until​​late​​2026,​​which​​means​​we​​cannot​​plan​​staffing,​​service​​mix​​or​ ​financial​​viability​​with​​any​​certainty​

​3.​​Thriving​​Kids:​​Private​​Practice​​Exclusion​​and​​the​​Risk​​of​​a​​Regional​​Service​ ​Gap​

​Concern​ ​This​​is​​the​​area​​of​​greatest​​concern​​for​​Active​​Health​​Riverina,​​and​​the​​one​​we​​believe​​is​ ​most​​poorly​​understood​​in​​the​​context​​of​​regional​​service​​delivery.​ ​A​​significant​​portion​​of​​our​​paediatric​​caseload​​consists​​of​​children​​who,​​under​​proposed​ ​changes​​taking​​effect​​from​​January​​2028,​​will​​be​​directed​​to​​the​​Thriving​​Kids​​program​​rather​ ​than​​the​​NDIS.​​Children​​aged​​8​​and​​under​​with​​developmental​​delay​​or​​autism​​with​​low​​to​ ​moderate​​support​​needs​​will​​no​​longer​​access​​individualised​​NDIS​​plans.​​They​​will​​instead​ ​be​​supported​​through​​a​​state-commissioned​​program.​ ​In​​NSW,​​the​​Thriving​​Kids​​delivery​​model​​has​​already​​been​​confirmed.​​Services​​will​​be​ ​delivered​​by​​non-government​​organisations​​commissioned​​by​​the​​Department​​of​ ​Communities​​and​​Justice​​(DCJ).​​Private​​providers​​will​​only​​be​​engaged​​in​​what​​DCJ​ ​describes​​as​​“limited​​circumstances”​​where​​NFP​​services​​are​​not​​available.​​This​​is​​not​​a​ ​minor​​procurement​​preference.​​It​​is​​DCJ’s​​structural​​policy,​​applied​​consistently​​across​​all​ ​human​​services​​it​​funds,​​including​​child​​protection,​​homelessness​​and​​out-of-home​​care.​ ​Thriving​​Kids​​in​​NSW​​is​​following​​the​​same​​framework.​ ​For​​Active​​Health​​Riverina,​​this​​means​​that​​a​​cohort​​of​​children​​we​​currently​​support​​through​ ​NDIS-funded​​paediatric​​physiotherapy​​may​​no​​longer​​be​​able​​to​​access​​our​​services​​under​ ​any​​funded​​pathway.​​We​​will​​not​​automatically​​transition​​into​​the​​Thriving​​Kids​​delivery​ ​model.​​We​​will​​need​​to​​be​​specifically​​engaged,​​either​​as​​a​​commissioned​​provider​​or​​as​​a​ ​subcontractor​​to​​a​​commissioned​​NFP,​​and​​neither​​pathway​​is​​currently​​confirmed​​for​​private​ ​practices​​in​​regional​​NSW.​ ​Following​​advocacy​​from​​peak​​bodies​​including​​Occupational​​Therapy​​Australia,​​DCJ​​has​ ​since​​indicated​​it​​is​​exploring​​a​​panel​​arrangement​​for​​private​​allied​​health​​providers.​​Further​ ​detail​​is​​promised​​in​​the​​second​​half​​of​​2026.​​This​​is​​welcome,​​but​​it​​does​​not​​resolve​​the​ ​core​​problem:​​private​​practices​​that​​currently​​hold​​the​​expertise,​​the​​client​​relationships​​and​ ​the​​workforce​​capacity​​to​​deliver​​paediatric​​allied​​health​​therapy​​in​​regional​​NSW​​are​​being​ ​structurally​​repositioned​​from​​primary​​providers​​to​​contingency​​options,​​without​​a​​clear​ ​transition​​plan​​for​​the​​families​​or​​the​​clinicians​​involved.​

Submission 660

​Why​​this​​is​​particularly​​acute​​in​​regional​​NSW​ ​In​​metropolitan​​areas,​​the​​NFP​​organisations​​likely​​to​​be​​commissioned​​for​​Thriving​​Kids​ ​already​​have​​established​​service​​footprints,​​workforce​​pipelines​​and​​referral​​networks.​​The​ ​transition,​​while​​disruptive,​​has​​some​​structural​​foundation​​to​​build​​on.​ ​In​​Wagga​​Wagga​​and​​the​​broader​​Riverina,​​the​​picture​​is​​different.​​The​​NFP​​organisations​ ​operating​​here​​are​​not​​currently​​delivering​​paediatric​​allied​​health​​therapy​​at​​scale.​​To​​do​​so​ ​under​​Thriving​​Kids,​​they​​will​​need​​to​​recruit​​qualified​​physiotherapists,​​exercise​ ​physiologists​​and​​podiatrists.​​Those​​clinicians​​currently​​work​​in​​practices​​like​​ours.​​This​ ​creates​​a​​direct​​and​​foreseeable​​workforce​​competition:​​the​​same​​people​​who​​are​​currently​ ​delivering​​the​​therapy​​component​​of​​early​​childhood​​intervention​​in​​our​​region​​will​​be​ ​targeted​​for​​employment​​by​​commissioned​​NFPs,​​potentially​​destabilising​​the​​regional​​allied​ ​health​​workforce​​at​​exactly​​the​​point​​when​​demand​​is​​expected​​to​​increase.​ ​Families​​currently​​on​​our​​waitlist​​for​​NDIS-funded​​paediatric​​physiotherapy​​need​​to​​know​ ​now​​whether​​the​​service​​they​​are​​waiting​​for​​will​​still​​exist​​in​​a​​form​​they​​can​​access.​​We​ ​cannot​​answer​​that​​question.​​The​​government​​has​​not​​provided​​enough​​operational​​detail​​for​ ​us​​to​​do​​so.​

​Likely​​real-world​​impact​ ​•​ ​Active​​Health​​Riverina​​stands​​to​​lose​​a​​significant​​portion​​of​​our​​paediatric​​referral​ ​base​​without​​a​​confirmed​​pathway​​into​​the​​system​​that​​replaces​​it​ ​•​ ​The​​Thriving​​Kids​​model​​removes​​consumer-directed​​choice.​​Families​​will​​not​​select​ ​their​​provider​​as​​they​​do​​under​​the​​NDIS.​​The​​relationship​​and​​trust​​built​​between​​our​ ​therapists​​and​​the​​children​​and​​families​​we​​work​​with​​does​​not​​automatically​​transfer​ ​to​​a​​commissioned​​service​​model​ ​•​ ​Commissioned​​NFPs​​will​​need​​to​​recruit​​qualified​​allied​​health​​clinicians​​to​​deliver​​the​ ​therapy​​component​​of​​Thriving​​Kids.​​In​​a​​regional​​labour​​market​​that​​is​​already​​thin,​ ​this​​creates​​direct​​competition​​with​​existing​​private​​practices​​for​​the​​same​​small​​pool​ ​of​​practitioners​ ​•​ ​Children​​currently​​receiving​​NDIS-funded​​paediatric​​therapy​​face​​a​​transition​​period​ ​during​​which​​their​​funding​​stream​​changes,​​their​​provider​​eligibility​​is​​unclear​​and​​the​ ​replacement​​program​​is​​not​​yet​​operational​ ​•​ ​The​​Advisory​​Group’s​​final​​report​​explicitly​​identified​​equity​​of​​access​​for​​regional,​ ​rural​​and​​disadvantaged​​communities​​as​​a​​guiding​​principle.​​The​​current​ ​procurement​​approach​​does​​not​​clearly​​demonstrate​​how​​allied​​health​​therapy​​will​​be​ ​delivered​​in​​regional​​NSW​​at​​the​​required​​scale​​and​​quality​​from​​October​​2026​ ​•​ ​If​​private​​practices​​are​​excluded​​from​​the​​Thriving​​Kids​​delivery​​model,​​and​​NDIS​ ​access​​is​​restricted​​for​​this​​cohort,​​the​​supply​​of​​paediatric​​allied​​health​​therapy​​in​ ​regional​​NSW​​does​​not​​increase.​​It​​is​​redistributed​​to​​a​​smaller​​number​​of​ ​commissioned​​organisations​​that​​do​​not​​yet​​have​​regional​​workforce​​capacity​ ​•​ ​Large​​NFPs​​are​​well​​positioned​​to​​win​​regional​​contracts​​in​​a​​tendering​​process.​ ​They​​are​​not​​necessarily​​well​​positioned​​to​​staff​​them​​in​​communities​​like​​Wagga​ ​Wagga,​​where​​recruiting​​qualified​​allied​​health​​clinicians​​is​​already​​a​​significant​ ​operational​​challenge​

​What​​we​​are​​asking​ ​We​​are​​not​​arguing​​that​​NFP​​organisations​​should​​be​​excluded​​from​​Thriving​​Kids.​​We​​are​ ​arguing​​that​​in​​regional​​NSW,​​excluding​​or​​limiting​​private​​practice​​providers​​from​ ​participating​​as​​primary​​providers​​is​​likely​​to​​produce​​a​​service​​gap​​that​​commissioned​​NFPs​ ​cannot​​fill​​on​​the​​required​​timeline.​​The​​families​​most​​at​​risk​​of​​that​​gap​​are​​the​​same​ ​families​​who​​are​​already​​furthest​​from​​alternative​​services.​

Submission 660

​4.​​Section​​48A:​​Stricter​​Thresholds​​for​​Unscheduled​​Reassessment​

​Concern​ ​The​​Bill​​tightens​​the​​circumstances​​under​​which​​an​​unscheduled​​plan​​reassessment​​can​​be​ ​triggered,​​requiring​​evidence​​of​​a​​significant​​and​​ongoing​​change​​in​​support​​needs.​​For​ ​children,​​this​​threshold​​does​​not​​reflect​​how​​development​​actually​​works.​​Children’s​​needs​ ​change​​because​​of​​growth,​​developmental​​progression,​​school​​transitions,​​changing​​family​ ​circumstances​​and​​the​​shifting​​participation​​demands​​of​​new​​environments.​​These​​changes​ ​are​​often​​gradual​​but​​clinically​​meaningful.​ ​For​​adults,​​the​​same​​problem​​applies​​differently.​​A​​participant​​recovering​​from​​acquired​​brain​ ​injury​​may​​reach​​a​​plateau​​and​​then​​make​​unexpected​​gains.​​A​​person​​with​​a​​progressive​ ​neurological​​condition​​may​​deteriorate​​in​​a​​way​​that​​is​​clinically​​significant​​but​​gradual.​ ​Requiring​​these​​participants​​to​​demonstrate​​a​​significant​​and​​ongoing​​change​​before​ ​accessing​​reassessment​​creates​​a​​system​​that​​is​​designed​​around​​administrative​ ​convenience​​rather​​than​​clinical​​reality.​

​Likely​​real-world​​impact​ ​•​ ​Children​​in​​paediatric​​physiotherapy​​may​​remain​​on​​outdated​​plans​​that​​no​​longer​ ​reflect​​their​​current​​developmental​​needs​​or​​functional​​capacity​ ​•​ ​Practitioners​​will​​be​​required​​to​​document​​deterioration​​rather​​than​​developmental​ ​progress​​or​​changing​​need​​to​​satisfy​​a​​reassessment​​threshold​ ​•​ ​Families​​will​​be​​pushed​​to​​crisis​​points​​before​​the​​system​​is​​designed​​to​​respond​ ​•​ ​In​​regional​​areas,​​where​​families​​have​​fewer​​informal​​support​​options​​to​​bridge​​gaps,​ ​the​​consequences​​of​​delayed​​reassessment​​are​​more​​severe​ ​•​ ​Critical​​developmental​​windows​​may​​close​​while​​children​​wait​​for​​plans​​that​ ​accurately​​reflect​​their​​current​​needs​

​5.​​Section​​34​​Changes:​​Support​​Must​​Arise​​Directly​​from​​an​​Eligible​ ​Impairment​

​Concern​ ​The​​Bill​​narrows​​the​​test​​for​​funded​​supports,​​requiring​​a​​more​​direct​​causal​​link​​between​​the​ ​support​​and​​the​​eligible​​impairment.​​In​​a​​practice​​working​​with​​children​​and​​adults​​across​​a​ ​range​​of​​conditions,​​this​​creates​​clinical​​and​​administrative​​problems​​that​​are​​not​ ​immediately​​obvious​​from​​reading​​the​​legislation.​ ​Children​​rarely​​present​​with​​a​​single​​isolated​​impairment.​​A​​child​​with​​autism​​who​​is​​also​ ​experiencing​​gait​​difficulties,​​reduced​​muscle​​tone,​​sensory​​processing​​challenges​​and​ ​difficulties​​with​​school​​participation​​has​​interconnected​​needs.​​The​​therapy​​we​​deliver​​does​ ​not​​map​​neatly​​onto​​discrete​​legislative​​categories.​​Adults​​with​​acquired​​disability​​frequently​ ​have​​secondary​​health​​consequences​​that​​are​​clearly​​related​​to​​their​​primary​​condition​​but​ ​that​​a​​narrow​​causal​​test​​may​​not​​capture​​without​​complex​​documentation.​

​Likely​​real-world​​impact​ ​•​ ​Clinicians​​will​​need​​to​​artificially​​separate​​needs​​that​​are​​functionally​​and​ ​developmentally​​interconnected​ ​•​ ​Reports​​will​​require​​more​​extensive​​justification​​for​​supports​​that​​are​​clinically​ ​straightforward,​​adding​​unpaid​​time​​and​​administrative​​cost​​to​​an​​already​​stretched​ ​regional​​practice​ ​•​ ​Multidisciplinary​​coordination​​becomes​​harder​​when​​each​​service​​stream​​must​ ​independently​​satisfy​​a​​causal​​link​​test​​rather​​than​​responding​​to​​the​​whole​​person​

Submission 660

​•​ ​Children​​and​​adults​​with​​complex​​or​​overlapping​​presentations​​are​​most​​vulnerable​​to​ ​funding​​gaps​​created​​by​​a​​narrow​​impairment-link​​requirement​

​6.​​Workforce​​and​​Regional​​Business​​Sustainability​

​Concern​ ​Each​​of​​the​​changes​​described​​above​​has​​consequences​​in​​isolation.​​The​​concern​​we​​want​ ​to​​put​​to​​the​​Committee​​is​​what​​happens​​when​​they​​arrive​​simultaneously​​in​​a​​regional​ ​market​​that​​has​​significantly​​less​​capacity​​to​​absorb​​disruption​​than​​a​​metropolitan​​one.​ ​Active​​Health​​Riverina​​has​​operated​​in​​this​​community​​for​​over​​25​​years.​​We​​have​​built​​our​ ​team,​​our​​referral​​networks​​and​​our​​NDIS​​capability​​over​​a​​long​​period.​​Recruiting​​qualified​ ​physiotherapists,​​exercise​​physiologists​​and​​podiatrists​​to​​Wagga​​Wagga​​is​​a​​genuine​ ​ongoing​​challenge.​​Our​​Coolamon​​clinic​​was​​a​​deliberate​​investment​​in​​extending​​access​​to​ ​a​​rural​​community​​that​​would​​otherwise​​have​​very​​limited​​local​​options.​​These​​are​​not​ ​decisions​​that​​can​​be​​quickly​​replaced​​if​​conditions​​become​​unsustainable.​

​Likely​​real-world​​impact​ ​•​ ​Therapists​​facing​​deteriorating​​NDIS​​funding​​conditions​​have​​a​​rational​​incentive​​to​ ​redirect​​their​​capacity​​to​​private​​and​​Medicare-funded​​caseloads​​where​​conditions​ ​are​​more​​stable​ ​•​ ​Commissioned​​Thriving​​Kids​​NFPs​​will​​compete​​for​​the​​same​​small​​regional​​allied​ ​health​​workforce,​​creating​​additional​​pressure​​on​​practices​​already​​finding​ ​recruitment​​difficult​ ​•​ ​Increased​​compliance​​and​​reporting​​requirements​​fall​​disproportionately​​on​​small​ ​practices​​without​​dedicated​​administrative​​or​​compliance​​support​ ​•​ ​The​​travel​​claiming​​reduction​​already​​in​​place​​has​​reduced​​the​​financial​​viability​​of​ ​outreach​​services​​to​​Coolamon​​and​​surrounding​​rural​​communities.​​Further​​funding​ ​pressure​​accelerates​​the​​case​​for​​withdrawing​​those​​services​ ​•​ ​If​​a​​small​​regional​​practice​​reduces​​NDIS​​intake,​​reduces​​rural​​outreach​​or​​closes,​ ​the​​community​​impact​​is​​not​​absorbed​​by​​nearby​​competitors.​​In​​many​​cases​​there​ ​are​​none​ ​•​ ​Schools​​and​​early​​learning​​settings​​across​​the​​Riverina​​are​​already​​managing​ ​significant​​unmet​​developmental​​and​​disability​​support​​needs​​among​​students.​ ​Reduced​​community​​access​​to​​allied​​health​​therapy​​increases​​pressure​​on​​teachers​ ​and​​school​​support​​staff​​who​​are​​not​​funded,​​trained​​or​​resourced​​to​​fill​​clinical​​roles​ ​•​ ​The​​downstream​​costs​​of​​reduced​​early​​intervention​​do​​not​​disappear​​from​​the​ ​budget.​​They​​shift​​to​​education,​​mental​​health,​​family​​support​​and​​later​​disability​ ​systems,​​often​​at​​greater​​total​​cost​

​Conclusion​ ​Active​​Health​​Riverina​​has​​been​​part​​of​​the​​Riverina​​community​​for​​over​​25​​years.​​We​​have​ ​watched​​the​​NDIS​​transform​​access​​to​​therapy​​for​​people​​in​​our​​region​​who​​previously​​had​ ​few​​options.​​We​​have​​invested​​in​​building​​the​​capacity​​to​​serve​​that​​community​​well,​ ​including​​establishing​​a​​rural​​clinic​​in​​Coolamon​​to​​reduce​​the​​travel​​burden​​on​​families​​who​ ​cannot​​easily​​get​​to​​Wagga​​Wagga.​ ​We​​support​​reform​​of​​the​​NDIS.​​We​​understand​​that​​the​​scheme​​needs​​to​​be​​sustainable.​ ​We​​are​​not​​making​​this​​submission​​to​​protect​​our​​revenue​​at​​the​​expense​​of​​good​​policy.​​We​ ​are​​making​​it​​because​​we​​work​​with​​real​​families​​in​​a​​real​​regional​​community,​​and​​we​​can​ ​see​​clearly​​how​​these​​changes​​will​​land​​for​​the​​people​​we​​treat​​every​​day.​

Submission 660

​The​​10​​per​​cent​​CBDA​​cut,​​differentiated​​pricing​​for​​unregistered​​providers,​​the​​Thriving​​Kids​ ​NFP-first​​procurement​​model,​​tighter​​reassessment​​thresholds​​and​​the​​narrowing​​of​​the​ ​impairment-support​​link​​are​​individually​​significant.​​Together,​​in​​a​​regional​​market​​with​​limited​ ​provider​​supply,​​thin​​workforce​​capacity​​and​​no​​metropolitan​​safety​​net​​of​​alternative​ ​services,​​their​​combined​​effect​​is​​a​​material​​risk​​to​​the​​continuity​​of​​allied​​health​​therapy​ ​access​​for​​some​​of​​the​​most​​vulnerable​​children​​and​​adults​​in​​our​​community.​ ​Children​​only​​have​​one​​early​​childhood.​​We​​ask​​the​​Committee​​to​​ensure​​that​​the​ ​sequencing,​​design​​and​​regional​​safeguards​​attached​​to​​these​​reforms​​are​​sufficient​​to​ ​protect​​access​​for​​the​​families​​in​​Wagga​​Wagga,​​Coolamon​​and​​the​​wider​​Riverina​​who​ ​depend​​on​​services​​like​​ours.​

​Practical​​Recommendations​ ​•​ ​Establish​​a​​clear​​and​​accessible​​pathway​​for​​private​​allied​​health​​providers​​to​ ​participate​​in​​Thriving​​Kids​​as​​primary​​providers,​​not​​only​​as​​a​​last​​resort,​ ​particularly​​in​​regional​​and​​rural​​areas​​where​​NFP​​workforce​​and​​service​​capacity​​is​ ​limited​ ​•​ ​Publish​​confirmed​​provider​​eligibility​​arrangements,​​panel​​processes​​and​ ​pricing​​for​​Thriving​​Kids​​in​​NSW​​before​​October​​2026​​so​​that​​families​​and​ ​providers​​can​​plan​​for​​the​​transition​​with​​certainty​ ​•​ ​Delay​​the​​restriction​​of​​NDIS​​access​​for​​mild-to-moderate​​paediatric​ ​presentations​​in​​any​​region​​until​​Thriving​​Kids​​services​​are​​demonstrably​​available​ ​at​​scale​​in​​that​​region,​​with​​confirmed​​workforce​​and​​delivery​​arrangements​​in​​place​ ​•​ ​Apply​​regional​​exemptions​​or​​loadings​​to​​differentiated​​pricing​​for​ ​unregistered​​providers​​in​​areas​​where​​registered​​provider​​supply​​is​​insufficient​​to​ ​meet​​participant​​demand,​​to​​avoid​​creating​​access​​gaps​​in​​already​​underserviced​ ​communities​ ​•​ ​Modify​​Section​​48A​​reassessment​​thresholds​​to​​recognise​​developmental​ ​change,​​childhood​​transitions​​and​​gradual​​but​​clinically​​meaningful​​change​​in​​adult​ ​participants​​as​​legitimate​​grounds​​for​​plan​​review,​​without​​requiring​​evidence​​of​ ​deterioration​​or​​crisis​ ​•​ ​Assess​​the​​cumulative​​impact​​of​​CBDA​​reductions,​​travel​​claiming​​changes​ ​and​​differentiated​​pricing​​together,​​on​​small​​regional​​provider​​viability,​​rather​​than​ ​treating​​each​​measure​​as​​independent​ ​•​ ​Require​​monitoring​​of​​regional​​access,​​workforce​​retention​​and​​provider​ ​viability​​as​​implementation​​proceeds,​​with​​a​​clear​​and​​responsive​​mechanism​​for​ ​adjusting​​settings​​where​​unintended​​consequences​​emerge,​​particularly​​in​​areas​​with​ ​limited​​provider​​supply​

​Active​​Health​​Riverina​ ​www.activehealthriverina.com.au​ ​May​​2026​