Access to therapeutic interventions for Australians with complex disabilities (Individual advocacy) | External submission

Submission 724

Applied Neuroscience Society17th ofAnnualAustralasiaANSASubmissionConferenceto the Senate Inquiry into The

National Disability Insurance Scheme Amendment (Securing the NDIS for Future

28thGenerations)– 29th OctoberBill 2026.2023

Improving Access to Evidence-Based Therapeutic Supports

that Enhance Functional Capacity

Executive Summary

This submission raises concerns regarding the exclusion of certain therapeutic interventions from NDIS funding through the operation of the “Not an NDIS Support” list, and the broader processes used to determine support eligibility. We note that the current Inquiry seeks to address the framework for assessing ‘reasonable and necessary’ supports and update principles applying to participants and their plans.

While the objective of ensuring public funds are directed toward effective and evidence-based supports is strongly supported, there is a risk that current arrangements may unintentionally

restrict  access  to  therapeutic  interventions  that  could  improve  functional  capacity,

participation, independence, and quality of life for some NDIS participants.

Particularly concerning is the potential impact on Australians living with complex neurological, developmental, cognitive, and psychosocial disabilities, for whom conventional interventions may not always produce sufficient improvements in functioning.

This submission recommends greater transparency, regular review of support classifications, stronger engagement with clinical experts, and the establishment of a clear mechanism through which emerging evidence can be considered when determining whether supports should be funded under the NDIS.

Background

The NDIS was  established  to  support  Australians  with  disability  to  achieve  greater

independence, social and economic participation, and improved functional capacity.

To achieve these objectives, participants must have access to interventions that are reasonably likely to improve functioning and reduce disability-related barriers.

The recent introduction of formal support lists has provided greater clarity regarding what may and may not be funded under the Scheme. However, concerns have been raised by disability organisations, mental health organisations, clinicians, participants, and families that the current framework may inadvertently limit access to potentially beneficial supports without providing a transparent pathway for reconsideration as evidence evolves.

Many participants with neurological, developmental, acquired brain injury, psychosocial, and

complex  disability  presentations  experience  significant  functional impairments  despite

receiving conventional interventions. For these individuals, access to innovative or emerging therapies may represent an important avenue for improving functioning, participation, self regulation, emotional wellbeing, cognition, communication, or independence.

CORRESPONDENCE: JILLIAN HARRINGTON, ANSA PRESIDENT

Submission 724

The Importance of Functional17thOutcomesAnnual ANSA Conference

The NDIS was designed as a functional support scheme rather than a diagnosis-based funding 28th – 29th October 2023 system.

Accordingly, decisions regarding support eligibility should focus on whether an intervention can reasonably be expected to improve disability-related functioning rather than whether a support conforms to traditional or historical models of intervention.

A number of therapeutic approaches currently excluded from funding are increasingly being investigated through peer-reviewed research and clinical practice. While the evidence base may vary between interventions and populations, it is important that emerging evidence is assessed through transparent and consistent processes.

Participants should not be disadvantaged simply because a therapy falls outside conventional categories if there is credible evidence suggesting potential functional benefit.

Concerns Regarding the Current Approach

Lack of Transparency

Stakeholders currently have limited visibility regarding:

 the evidence review processes used to determine support eligibility;

 the threshold of evidence required for inclusion or exclusion;

 how competing evidence is weighed;

 how new evidence may be submitted and reviewed; and

 whether support classifications are periodically reassessed.

Greater transparency would improve confidence in decision-making and allow participants, clinicians, researchers, and advocacy organisations to better understand the rationale underpinning funding decisions.

Risk of Excluding Beneficial Supports

The current framework may create circumstances where participants are unable to access interventions that could improve:

 emotional regulation;

 attention and concentration;

 executive functioning;

 behavioural self-management;

 social participation;

 daily living skills;

 community engagement; and overall independence.

CORRESPONDENCE: JILLIAN HARRINGTON, ANSA PRESIDENT

Submission 724

For participants with complex17thandAnnualtreatment-resistantANSA Conferencepresentations, excluding potentially beneficial interventions may reduce opportunities to improve functional capacity and increase long-term dependence on funded28thsupports.– 29th October 2023

Impact on Vulnerable Australians

The greatest impact is likely to be experienced by participants who:

 have exhausted conventional treatment pathways;

 experience chronic and complex disability;

 live in regional and rural areas with limited service options;

 have acquired neurological injuries;

 experience psychosocial disability;

 are autistic or neurodivergent; or

 require highly individualised approaches to improve functioning.

These participants may be disproportionately affected by rigid funding classifications that do not adequately account for individual variation in response to intervention.

Recommendations

Recommendation 1

Establish an independent, transparent evidence review framework for therapeutic supports funded under the NDIS. While acknowledging the NDIS Evidence Advisory Committee process may be suitable for mainstream supports, to support participant access to innovative therapies where evidence may still be at the Emerging stage, we recommend a more nuanced approach:

This framework should clearly articulate:

 evidence thresholds;

 review methodology;

 expert consultation processes; and

 reasons for inclusion or exclusion decisions.

Recommendation 2

Introduce a formal pathway for emerging therapies to be reviewed and reconsidered as new evidence becomes available.

This process should allow submissions from:

 professional associations;

 researchers;

 disability organisations;

 clinicians; and

CORRESPONDENCE: JILLIAN HARRINGTON, ANSA PRESIDENT

Submission 724

 participant advocacy groups.17th Annual ANSA Conference Recommendation 3 28th – 29th October 2023 Require periodic review of all supports listed as “Not an NDIS Support.”

Evidence evolves over time, and support classifications should not become effectively permanent without ongoing reassessment.

Recommendation 4

Require clear, evidence-based and professionally supported definition of all supports listed as “Not an NDIS Support.”

As an example, the inclusion of Neurofeedback, without any definition, as “Not an NDIS Support”, saw professional services provided by registered health practitioners with extensive training and international certification in applying evidence-based assessment and therapy supports, lumped together with the rental of “off the shelf” devices offered by non-clinicians on a commercial rental basis. This confusion of evidence-based professional therapy with a significant evidence-base in providing functional improvement for people with disability, with an untested commercial product delivered without clinical oversight, has deprived many NDIS participants and their families, access to potentially life-changing support.

Recommendation 5

Ensure support eligibility decisions remain focused on disability-related functional outcomes rather than solely on historical classifications of interventions.

The central question should be whether a support is reasonably likely to improve functional capacity, participation, independence, or quality of life for people with disability.

Recommendation 6

Increase representation from disability clinicians, allied health professionals, researchers, and lived-experience representatives in support classification processes.

Recommendation 7

Develop a mechanism for exceptional individual consideration where there is credible clinical evidence that a participant may benefit from an intervention that is not routinely funded.

Such a mechanism would preserve participant choice while maintaining appropriate safeguards and accountability.

CORRESPONDENCE: JILLIAN HARRINGTON, ANSA PRESIDENT

Submission 724

Conclusion 17th Annual ANSA Conference

The NDIS has transformed the lives28thof– many29th OctoberAustralians2023with disability by supporting greater independence and participation in community life.

As the Scheme continues to evolve, it is important that funding frameworks remain sufficiently flexible to recognise emerging evidence, encourage innovation, and respond to the diverse needs of participants.

A transparent and regularly reviewed approach to therapeutic support eligibility would help ensure that vulnerable Australians are not denied access to interventions that may improve functional capacity, reduce long-term disability-related impacts, and enhance quality of life.

The objective should not be to fund all therapies indiscriminately, but rather to ensure that

evidence  is evaluated  fairly, transparently, and consistently, with participant outcomes

remaining at the centre of decision-making.

The Applied Neuroscience Society of Australasia is a membership organization comprised of Health

Professionals  including  Psychiatrists,  Psychologists,  Occupational  Therapists,  Social  Workers,

Chiropractors and other practitioners from Australia, Australasia and New Zealand, involved in the promotion of better mental health. ANSA promotes education and professional excellence in the fields of Applied Psychophysiology, Neurotherapy and Nutrition seeking to obtain broad acceptance of this combination of disciplines as a viable treatment approach in mental health.

Neurofeedback also called Neurotherapy, EEG Biofeedback or EEG Operant Conditioning, is the most commonly used form of regulation of brain electrical activity. It is often used in conjunction with other forms of Biofeedback as well as medicine, clinical and educational psychology, social work, nursing, chiropractic, physiotherapy and some nutritional approaches.