Clinical assessment concerns for regional participants (Provider advocacy)

Submission 807

Elephant in the Room Training & Consultancy Telephone: Website: www.elephantintheroom.net.au Email: admin@elephantintheroom.net.au Registered NDIS Provider:

SUBMISSION TO THE SENATE COMMUNITY AFFAIRS LEGISLATION COMMITTEE

National Disability Insurance Scheme Amendment

(Securing the NDIS for Future Generations) Bill 2026 Submitted by: Elephant in the Room – Training and Consultancy Pty Ltd

Registered NDIS Provider | Allied Health - Support Coordination - Behaviour Support - Key Worker - Plan Management

Operating across Regional and Remote New South Wales

Contact: Natalie. Mudford - Director/Speech Pathologist,

Date: 1 June 2026

1. Introduction and Position Elephant in the Room is a proud registered NDIS provider delivering allied health and therapy services, support coordination, specialist behaviour support, key worker services, and plan management across regional and remote New South Wales. We chose registration and carry its full compliance obligations willingly, because we believe registration reflects a genuine commitment to participant safety and quality.

We support the Government’s goal of placing the NDIS on a sustainable footing. However, we are concerned that the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026 (the Bill), as drafted, will cause direct harm to participants — particularly in regional and remote communities — by restricting access, undermining clinical standards, and concentrating power in the executive without adequate oversight. This submission addresses four areas of concern and makes eight recommendations.

2. The Functional Capacity Assessment Framework 2.1 No algorithm can replace sound clinical judgement

The Bill proposes a standardised functional capacity assessment framework premised on the assumption that a scored instrument can objectively determine a person’s support needs. We strongly contest this. The assessment of functional capacity is an inherently clinical act — one that requires professional training, therapeutic relationship, contextual knowledge, and nuanced judgement that cannot be captured by an algorithm or a point-in-time tool.

Functional capacity is multi-dimensional and context-dependent. It is shaped by environment, family situation, trauma history, communication needs, and the fluctuating nature of a person’s condition. A clinician who knows a participant over time has access to qualitative knowledge that no tool can replicate. A standardised framework that is consistently applied but clinically inaccurate is not an improvement — it is a systemic failure at scale. The Government has not provided publicly available evidence that any proposed instrument has been validated across the full breadth of disability presentations in the NDIS. Until that evidence is produced, the case for replacing clinical judgement with an algorithmic framework has not been made.

2.2 Assessments must be conducted by qualified clinicians

The Bill does not, as currently drafted, require assessors to hold relevant allied health qualifications or AHPRA registration. This is a fundamental patient safety concern. Decisions about whether a person can access the NDIS — and what supports they receive — must not be made by individuals who lack the professional training, scope-of practice obligations, and disciplinary accountability that govern registered practitioners. Provider registration governs

Submission 807

the organisation; it does not guarantee that the individual conducting an assessment has the clinical competency to do so safely or ethically.

2.3 Variable and episodic conditions

Many participants supported by allied health providers present with episodic, fluctuating, or progressive conditions — including acquired brain injury, multiple sclerosis, and complex psychosocial disability. A point-in-time assessment framework risks capturing these participants at a moment of relative capacity and systematically underestimating their genuine needs. Any framework introduced under the Bill must include provisions that require assessors to account for variability and fluctuation over time.

2.4 Financial sustainability as a legal test

The Bill amends Section 3(1)(d) of the NDIS Act to qualify support provision ‘so far as is consistent with the financial sustainability of the scheme.’ These words have never appeared in the Act before. The NDIS was designed as a needs based entitlement. By embedding a fiscal qualifier on the face of the Act, the Bill creates a legal basis for denying supports on budgetary grounds — not clinical grounds. We recommend this amendment be removed or substantially modified, and the Committee consider whether it is consistent with Australia’s obligations under the UN Convention on the Rights of Persons with Disabilities.

3. Impact on Regional and Remote Communities We operate exclusively across regional and remote New South Wales — areas already characterised by thin markets, workforce shortages, and significant barriers to accessing disability supports. The Bill’s proposed changes will compound these existing inequities in ways that appear to have received little consideration in the design of the reforms.

Finding suitably qualified allied health professionals, behaviour support practitioners, and support workers is already a critical challenge in our communities. The Bill’s proposed functional capacity assessment framework, combined with changes to eligibility, will create additional demand for qualified assessors in communities where none currently exist. If assessments must be obtained before eligibility is confirmed, participants in our region face the prospect of lengthy delays, the cost of travel to access assessors, or being assessed by practitioners who do not know them, their community, or their circumstances.

More broadly, any reduction in the number of participants eligible for the NDIS will disproportionately affect people in regional and remote areas, where the NDIS is often the only structured support system available. In metropolitan areas, participants exited from the scheme may be able to access some mainstream services. In our communities, no equivalent alternative exists. For these participants, exit from the NDIS is not redirection to another system — it is abandonment.

We urge the Committee to require the Government to produce a regional and remote impact assessment for the Bill before it is passed, and to ensure that any new eligibility or assessment requirements cannot commence in thin market areas without adequate workforce infrastructure being in place.

4. Provider Registration and Specialist Service Streams We support the expansion of mandatory provider registration as a safeguard for participants most at risk. However, we raise three specific concerns as a registered provider operating across multiple specialist streams.

First, in relation to behaviour support: expanding mandatory registration of providers is necessary but insufficient if practitioner-level qualification requirements remain unclear. Behaviour support involves assessment and management of behaviours of concern, the development of behaviour support plans, and in some cases authorisation

Submission 807

of regulated restrictive practices. These functions carry profound responsibility for participant safety and dignity. Registration of the provider organisation does not, on its own, ensure the practitioner has the required competency.

Second, in relation to support coordination and plan management: these roles sit at the intersection of every other service stream. Our coordinators and plan managers are often the first to observe when plans are inadequate, when funding has been wrongly denied, or when a participant is at risk. The Bill’s changes to eligibility, planning, and what the scheme will fund will substantially increase the complexity of this work — without any corresponding increase in the resources allocated to deliver it.

We are particularly concerned about regulatory and policy directions that favour the centralisation of plan management to large platform-based or automated providers. This trend runs directly counter to the Government’s stated integrity objectives and is acutely harmful for participants in regional and remote communities.

Plan management is not a transactional or administrative function. Effective plan management requires a real person who knows the participant, understands their funded supports, recognises their regular providers, and can identify when something does not look right. Platform-based plan management providers that rely on automated invoice scanning and processing systems do not provide this. An automated system will process any invoice that passes a format check. It has no knowledge of whether the provider is known to the participant, whether the service was actually delivered, whether the amount is consistent with the participant’s plan, or whether the claim pattern suggests exploitation. A local plan manager who knows their participant will notice these things immediately.

This is not a theoretical concern. The NDIS fraud and integrity problems the Government has identified are disproportionately concentrated in environments where there is no human relationship between the participant, their plan manager, and their providers. Automated processing systems create precisely the conditions in which fraudulent invoicing thrives: high volume, low scrutiny, no local knowledge, and no person whose job it is to ask questions. If the Government is serious about scheme integrity, it should be strengthening the role of locally-based, relationship centred plan managers — not creating conditions that favour their displacement by platforms that process claims without a human eye.

The same logic applies to support coordination. A support coordinator who is local to a regional or remote community holds irreplaceable knowledge: they know which providers operate in the area, which ones are reputable, what services are genuinely available, and what the participant’s life actually looks like. A centralised coordinator managing caseloads remotely, without connection to the community or the participant, cannot perform this function. For participants in our communities, the loss of a local support coordinator is not a minor inconvenience — it leaves them without anyone who can effectively navigate services on their behalf.

We recommend the Committee scrutinise any provisions or regulatory directions in or arising from the Bill that would favour centralised or automated plan management and support coordination models, and recommend instead that quality standards explicitly recognise and protect the value of local, relationship-based service delivery — particularly in regional and remote areas where it is the only model that can work.

Third, in relation to key worker services: the key worker model is an evidence-based, relationship-centred approach to early childhood support that depends on continuity, holistic knowledge, and trusted connection. It is precisely the kind of approach that the Bill’s preference for standardised, episodic assessment risks making unviable. We urge the Committee to ensure the Bill does not inadvertently defund or narrow relationship-based models that have demonstrated outcomes for children and families.

5. Parliamentary Oversight and Review Rights The Bill delegates significant decision-making power to ministerial rules — including the power to define what supports the NDIS will fund, the parameters of the functional capacity framework, and conditions of provider registration. These are not administrative details; they are matters that directly determine the rights and entitlements of people with disability. The ability to alter them by ministerial instrument — without requiring primary legislation —

Submission 807

means participant rights can be reduced without full parliamentary scrutiny. We recommend that key definitions and eligibility criteria be subject to primary legislation or, at minimum, affirmative disallowance by both Houses.

We are also concerned about the cumulative erosion of merits review rights. An accessible, independent review pathway is a structural safeguard that ensures the NDIA exercises its powers correctly. Our coordinators and allied health practitioners regularly support participants through review processes, and we observe directly how often NDIA decisions are overturned or settled in the participant’s favour. Restricting review rights in this environment is not a cost-saving measure — it is a removal of accountability. Review rights must be preserved and strengthened, particularly for participants with complex needs and limited capacity to self-advocate.

6. The Consultation Process We place on record our serious concern about the adequacy of consultation on this Bill. A 109-page Bill, introducing changes that affect eligibility, planning, funding, provider registration, and review rights across the entire NDIS, was introduced on 14 May 2026 with an original Senate Committee submission deadline of 29 May 2026 — fifteen days. While the deadline was subsequently extended to 1 June 2026, the extension of a further three days does not meaningfully address the inadequacy of the consultation period. Eighteen days is not genuine consultation on legislation of this scale and consequence.

For a provider operating across regional and remote NSW, the compressed timeline is particularly acute. We must analyse the legislation, consult with our clinical and coordination teams, consider impacts on our participants, and prepare a written submission — while continuing to deliver services to people who depend on us. We recommend the Committee call for an extended consultation period and commit to a genuine co-design process for key provisions — particularly the functional capacity assessment framework — before those provisions are given legal effect.

7. Recommendations We make the following recommendations to the Committee:

• Rec. 1: Remove or substantially modify the amendment to s.3(1)(d) that embeds financial sustainability as a qualifying condition for participant supports, to ensure access remains grounded in individual need and consistent with Australia’s CRPD obligations.

• Rec. 2: Require that any functional capacity assessment be conducted by, or under the direct clinical supervision of, a suitably qualified and AHPRA-registered allied health professional with demonstrated competency in disability assessment.

• Rec. 3: Require the Government to publicly release validation evidence for any proposed assessment instrument across the full range of NDIS disability presentations before the framework commences.

• Rec. 4: Require the assessment framework to explicitly account for episodic, variable, and progressive conditions, supported by co-design with the disability community.

• Rec. 5: Commission and publish a regional and remote impact assessment for the Bill’s eligibility and workforce provisions, and ensure new requirements cannot commence in thin-market areas without adequate workforce infrastructure.

• Rec. 6: Reject any regulatory direction that favours centralised or automated platform providers for plan management or support coordination at the expense of locally-based, relationship-centred providers. Quality standards must explicitly recognise the value of local knowledge and human oversight — particularly in regional and remote areas. Automated invoice processing systems, which operate without human scrutiny of individual claims, must not be treated as equivalent to plan management delivered by a person who knows the participant.

• Rec. 7: Elevate key eligibility criteria and support definitions to primary legislation, or require affirmative disallowance by both Houses, rather than permitting alteration by ministerial rule. Preserve and strengthen merits review rights.

• Rec. 8: Extend the public consultation period and commit to genuine co-design with people with disability and the disability sector before key provisions of the Bill are given effect.

Submission 807

• Rec. 7: Extend the public consultation period and commit to genuine co-design with people with disability and the disability sector before key provisions of the Bill are given effect.

8. Conclusion We support a sustainable NDIS. We do not support a Bill that achieves sustainability by restricting access for the most vulnerable, bypassing clinical expertise, removing parliamentary accountability, and ignoring the realities of regional and remote communities where the NDIS is the only safety net that exists.

The NDIS changed lives. It can continue to do so — but only if it remains grounded in individual need, clinical integrity, and genuine partnership with the disability community. We urge the Committee to recommend substantive amendments before this Bill is passed.

Submitted by: Natalie Mudford – Director/Speech Pathologist

Elephant in the Room Training and Consultancy Pty Ltd | 1st June 2026