Court Garfoot Clinical Director BHSc (Nut. Med.), LLB, BMgmt

a Paediatric Allied Heatth Clinic

JuniPaediatrics.com.au May 20, 2026

Committee Secretary

Standing Committee on Health, Aged Care and Disability House of Representatives

Parliament House, Canberra ACT 2600

Re: Submission - National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026

Dear Committee Secretary,

Thank you for the opportunity to provide a submission on the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (the Bill). | write as Clinical Director of Juni Paediatrics, a paediatric allied health clinic that provides clinical nutrition care to children with disability, complex feeding presentations, and developmental disorders, and engages Certified Practising Nutritionists (CPN) registered with the Australian Association of Registered Practising Nutritionists (AARPN). Many of the children and families we work with are current or prospective NDIS participants.

This submission supports the Government’s objective of securing the long-term sustainability of the NDIS while urging that the reforms preserve and strengthen access to clinical nutrition supports for children with disabilities — a population for whom nutrition is not adjunctive but foundational to functional capacity, development, and the very outcomes the Scheme is intended to deliver. Comments are organised by the relevant provisions of the Bill.

1. Recognition of Certified Practising Nutritionists (CPNs) and strengthened evidence requirements

The Bill’s emphasis on clearer assessment thresholds, stronger evidence, and a more robust approach to determining eligibility is welcome. The Explanatory Memorandum acknowledges that current evidence requirements are “unclear and often burdensome,” and that delegates rely heavily on external reports from treating professionals - a system that creates inequities and disempowers families.

As the Bill’s framework will be operationalised through subordinate NDIS rules, legislative instruments and assessment tools,

I respectfully ask the Committee to recommend that:

e Futurerules and assessment frameworks continue to recognise registered Certified Practising Nutritionists (CPNs) as suitably qualified health professionals for the purposes of providing functional capacity evidence, treatment evidence, and supporting documentation under the NDS, alongside other registered allied health practitioners.

e Anystrengthened evidence requirements introduced through rules, the new needs assessment process, or the operational guidance underpinning sections 24, 25 and 25A explicitly identify clinical nutrition assessments by CPNs and Accredited Practising Dietitians as accepted forms of evidence for impairments and conditions where nutrition is a primary determinant of functional capacity - including paediatric feeding disorders, ARFID, failure to thrive, malnutrition secondary to disability, and feeding presentations arising from autism spectrum disorder, cerebral palsy, intellectual disability and genetic syndromes.

CPNs meet the recognised education, supervised practice, scope of practice, continuing professional development and code-of-conduct standards as other allied health professionals already recognised by the NDIS, such as Accredited Practising Dietitians. Excluding or omitting CPNs from any new evidentiary frameworks would not strengthen the integrity of NDIS evidence, it would reduce the qualified workforce available to families, inecrease out-of-pocket costs, and worsen the very access inequities the Bill seeks to address. Express recognition would deliver on the Government’s stated objective of a more consistent, transparent and equitable approach to evidence, while protecting Scheme integrity.

2. Sections 25 and 25A - Early intervention and ‘all appropriate treatment’

Items 90-92 of Schedule 1 amend section 25 and insert a new section 25A defining “appropriate treatment” for the purposes of the permanence and early intervention criteria. The intent of ensuring evidence-based and reliably effective treatment is sound. | offer the following observations from a paediatric clinical nutrition perspective.

2.1 Nutrition as a foundation for all participants with disability

I respectfully ask the Committee to recommend that the operation of sections 25 and 25A, and the rules that will follow, explicitly acknowledge the importance of nutrition as a foundational support for all people living with a disability. Nutrition is not a parallel concern that sits beside disability supports; it underwrites them.

Across the paediatric disability population, adequate nutrition is the substrate on which every other reasonable and necessary support depends. A child who is undernourished, dehydrated, micronutrient depleted, or in a state of feeding dysregulation cannot reliably benefit from speech pathology, occupational therapy, physiotherapy, behavioural

Nutrition’s Foundational Role

support, or educational supports. Conversely, children whose nutritional status is stabilised through targeted clinical nutrition intervention show measurable improvements in attention, behaviour, sleep, growth, gastrointestinal function and immune resilience with therapy. Nutrition is a foundational, capacity-enabling support, not an adjunct or lifestyle service.

Recognising this foundational role in sections 25 and 25A would ensure that early intervention decisions, the assessment of “appropriate treatment,” and the design of needs assessment tools do not inadvertently treat clinical nutrition as optional or substitutable. It would also align the Act with current paediatric clinical practice, the Disability Royal Commission’s findings on the unmet health needs of people with disability, and the NDIS Review’s call for capacity-building supports that produce durable functional gains.

Operational concerns with the ‘appropriate treatment’ test

Section 25A(1) defines appropriate treatment as treatment that is evidence-based, can reliably be expected to materially improve, reverse or alleviate the impairment, and is regularly undertaken in Australia. Section 25A(2) provides that treatment may be “appropriate” regardless of whether a person’s individual circumstances restrict their access to it. | urge the Committee to ensure that:

e For paediatric populations, the assessment of “all appropriate treatment” explicitly recognises feeding therapy, clinical nutrition intervention, and multidisciplinary feeding clinics as components of appropriate treatment where indicated, rather than as upstream prerequisites that families must self-fund before NDIS access is considered.

e Geographic and workforce realities are taken into account in the rules. Many regional and remote families cannot access multidisciplinary feeding teams or paediatric clinical nutrition services within reasonable timeframes; deeming such treatment “appropriate” regardless of access would unfairly exclude these children from the Scheme.

e Treatment is only considered to “reliably” produce improvement where there is high-quality evidence for the specific paediatric population concerned. For many disability-associated nutrition conditions (e.g. ARFID with autism spectrum disorder, oro-motor dysfunction in cerebral palsy, syndromic feeding presentations), evidence for full reversal is limited; the criterion of “reliably” producing material improvement must not be applied so strictly as to deny access where ongoing, capacity-maintaining nutrition support is clearly required.

Section 34(1G)-(1J) - Parental responsibility and children with disability

The proposed subsections 34(1G)-(1J) require the CEO, when deciding whether a support is reasonable and necessary for a child, to take into account the presumption that parents are responsible for providing substantial care and support, and prohibit the CEO

from being satisfied that a support is reasonable and necessary if its primary or

substantial purpose is to reduce burdens on parental time, improve household efficiency, or substitute parental care.

The policy intent of ensuring NDIS supports complement rather than displace ordinary parental responsibility is understandable. However, as currently drafted, these provisions risk being applied in ways that exclude clinically essential supports for children whose disability creates needs that fall well outside what could reasonably be expected of any parent. | respectfully ask the Committee to recommend that:

• Subsections 34(1G)-(1J) (and any supporting rules or operational guidance) extremely recognise paediatric feeding disorders and disability-associated nutrition conditions (e.g. ARFID with autism spectrum disorder, oro-motor dysfunction in cerebral palsy, syndromic feeding presentations), as conditions where the supports require specialist clinical nutrition assessment, structured feeding therapy, parental coaching, and ongoing review are not substitutes for, or reductions of, ordinary parental care.

Paediatric feeding disorders and ARFID are well-recognised clinical entities. They commonly co-occur with autism spectrum disorder, intellectual disability, sensory processing disorders, and gastrointestinal conditions. They are characterised by severe food selectivity, sensory-based aversions, distress and dysregulation around eating, inadequate dietary diversity, and significant nutritional, growth and psychosocial consequences. In my own clinical practice, the typical paediatric feeding disorder presentation involves a child with five to fifteen “safe” foods, intense distress when novel foods are presented, and a family that has already tried, often for years, every “ordinary parental” strategy.

The supports required to address these presentations including specialist clinical nutrition assessment, evidence-based feeding therapy protocols, structured exposure planning, and clinician-led parent coaching, are squarely within the scope of clinical treatment. They are not equivalent to a parent preparing a meal, encouraging a child to try a new food, or making a school lunch. Treating them as falling within “substantial care and support” ordinarily provided by parents would deny children with disability access to evidence-based clinical care, increase the risk of malnutrition and developmental harm, and shift the financial burden of disability-specific treatment back onto families.

| therefore ask the Committee to recommend an amendment, or accompanying explanatory note, clarifying that subsection 34(lJ) is not intended to capture clinical nutrition assessment and feeding intervention for paediatric feeding disorders and disability-associated nutrition conditions (e.g. ARFID with autism spectrum disorder, oro-motor dysfunction in cerebral palsy, syndromic feeding presentations), and that the subsection 34(IH) reference to assistance “reasonably expected of a parent of a child of a similar age” is to be interpreted by reference to typical paediatric expectations, not to expectations adjusted upward to reflect the demands of caring for a child with disability.

4. Clinical illustration

To illustrate why the recognition sought above matters in practice, | briefly describe a representative paediatric case from my clinic (de-identified).

A six-year-old boy was referred for severe food selectivity that had developed over a three-year period. He was diagnosed with autism spectrum disorder shortly after his first consultation. His diet was dominated by discretionary foods, with approximately ten “safe” foods; he experienced significant distress (“meltdowns”) when other foods were presented. He had loose stools up to twice per month, monthly headaches, poor sleep and concentration, and required additional support at school. His parents had already exhausted ordinary parental strategies before referral.

Treatment involved a four-phase clinical protocol over six months - desensitisation to processed flavourings, sensory experimentation with novel foods, taste exposure without pressure, and structured repeated exposures to novel foods. Family-centred communication frameworks were used to support shared decision-making with the child. Over the course of treatment, his dietary range expanded substantially, his behavioural symptoms improved, and his engagement at school increased.

This is the kind of intervention that the Bill’s sections 25, 25A and 34(1G)-(1J) will directly affect. It is not parental care. It is not lifestyle nutrition. It is clinical, evidence-based, capacity-building disability treatment delivered by a registered healthcare professional. The legislative and regulatory framework must continue to enable access to such care for the children who need it.

access multidisciplinary feeding services or for whom full reversal of impairment is

totally unrealistic clinically.

• Recommendation 5: That subsections 34(1G)-(1J) (and any explanatory or operational guidance) explicitly acknowledge paediatric feeding disorders and disability-related nutritional conditions (for example, ARFID associated with autism spectrum disorder, oral motor difficulties related to cerebral palsy, syndrome-based eating presentations), as medical situations where therapy does not fall under the assumption of “significant parental attention and assistance,” nor should they be ruled out due to subsection 34(1J).

I would appreciate having a chance to elaborate more about anything discussed here, such as offering additional practical examples or research findings to the Committee.

Kind regards,

Courtney Garfoot

Clinical Head & Lead Specialist in Child Health Nutritional Care BHSc (Nutr. Med.), LLB, BMgmt