Functional capacity assessments inconsistent with cohort-based funding assumptions (Individual advocacy)

Submission 837

Submission to the Senate Community Affairs Legislation Committee

Inquiry into the National Disability Insurance Scheme Amendment (Securing the

NDIS for Future Generations) Bill 2026

Submitted by:

Senior Occupational Therapist / Occupational Therapy Driving Assessor

Being Able Pty Ltd

Introduction

I am a Senior Occupational Therapist and Occupational Therapy Driving Assessor with extensive clinical experience working with people with disability, including NDIS participants with physical, neurological, psychosocial, developmental and progressive conditions. My clinical work includes functional capacity assessments, assistive technology prescription, home modification assessments, Specialist Disability Accommodation assessments, driving assessments, and reports to support access to reasonable and necessary supports under the NDIS.

This submission directly addresses the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026, particularly the proposed changes relating to access, planning, funding, reassessment, reasonable and necessary supports, functional capacity assessment, and scheme sustainability.

I support measures that improve the sustainability, integrity and appropriate use of NDIS funds. I acknowledge that the NDIS must be financially sustainable and that public funds should be used responsibly. However, I am concerned that aspects of the Bill risk moving the Scheme away from its original purpose as an individualised, person centred scheme based on functional need, goals, participation, and choice and control.

In my view, reforms should focus on reducing administrative inefficiency, improving evidence-based decision-making, streamlining access to low-risk supports, and reusing existing equipment where clinically appropriate. These approaches would assist with sustainability without imposing broad funding restrictions or standardised assumptions that may not reflect the person’s actual functional capacity, environment, goals, risks or participation needs.

Submission 837

Concern regarding planning and funding changes that reduce individualisation

I am concerned that the Bill’s proposed planning and funding changes may permit broad funding reductions, limits or determinations that do not adequately reflect individual functional need. Any reforms that allow support categories, disability cohorts, or types of supports to be reduced or capped without sufficient individual assessment risk undermining the core principles of the NDIS.

In clinical practice, a person’s diagnosis or disability category does not determine their functional capacity, support needs, environmental barriers, participation goals, work requirements, family situation or risk profile. This is particularly important in occupational therapy, where assessment is based on the interaction between the person, their occupations, and their environment. Client-centred practice requires that supports are considered in relation to the individual’s actual daily life, not simply their diagnosis or broad disability cohort.

For example, two participants with the same diagnosis of Multiple Sclerosis may have very different clinical presentations. One participant may remain ambulant for short distances but experience significant fatigue, reduced balance and intermittent falls risk. Another participant with the same diagnosis may be fully wheelchair dependent, require hoisting for transfers, require pressure care equipment, and need extensive home modifications to safely complete personal care and domestic activities. Treating these participants as though they have the same support needs because they fall within the same diagnostic cohort is not clinically appropriate.

The same applies across many disability groups. In my clinical practice, I have worked with participants with lower limb amputation whose needs differ substantially depending on prosthetic use, home environment, work role and community participation. For example, one participant may live on a rural property, use a prosthesis, and require safe access across uneven terrain to complete property-based and work-related tasks. Another participant with the same broad disability type may be unable to use a prosthesis and may be fully wheelchair dependent within a suburban home. These participants may share a similar disability category, but their functional needs, risks, environmental barriers and reasonable and necessary supports are materially different.

This highlights why broad cohort-based funding assumptions are inconsistent with choice and control. They risk placing people with the same diagnosis or disability type into the same “basket”, despite significant differences in their functional presentation, personal circumstances, goals, work roles, home environments and participation needs.

Submission 837

Choice and control must remain central to the NDIS

The original intent of the NDIS was to provide people with disability with greater choice and control over the supports they receive, and to enable them to pursue their goals and participate in ordinary life. The proposed changes in the Bill should be carefully considered to ensure they do not undermine this foundational principle.

A standardised or capped approach to supports may appear administratively efficient, but it risks reducing the capacity of participants and clinicians to identify what is actually required in the person’s individual circumstances. In occupational therapy practice, supports are not recommended simply because a person has a diagnosis. Supports are recommended because there is a functional need, risk, environmental barrier, participation restriction, or safety issue that can be addressed through appropriate intervention.

The NDIS should continue to fund supports based on individualised assessment of functional need, rather than broad assumptions about what a cohort of participants should receive.

Concern regarding reasonable and necessary supports

I am concerned that changes to the reasonable and necessary provisions may narrow how supports are considered and funded. While it is appropriate that supports should be evidence-based, effective, beneficial and value for money, these criteria must be applied in a way that reflects the participant’s real-world function, environment and goals.

Occupational therapy recommendations are based on functional assessment. This includes consideration of the participant’s daily activities, home environment, community access, work or study participation, informal supports, risks, and the likely outcome if supports are not provided. A support may appear similar across participants, but the clinical rationale may be very different depending on the person’s circumstances.

For example, two participants may both require a mobility aid, home modification or assistive technology item, but the reason, urgency, risk profile and functional benefit may differ significantly. One participant may require equipment to prevent falls and hospital admission, while another may require equipment to maintain work participation or access essential areas of their property. These differences are clinically relevant and should not be lost through standardised funding assumptions.

Reasonable and necessary decisions should remain individualised and should continue to consider the participant’s functional capacity, environment, risks, goals, and participation needs.

Submission 837

Concern regarding repeated functional assessments for permanent and degenerative disabilities

I am also concerned about any approach under the Bill that requires participants with permanent or degenerative disabilities to repeatedly prove the existence and impact of their disability where permanence has already been established.

For participants with permanent and degenerative conditions, frequent reassessment to re-confirm disability status is not an efficient use of NDIS funds. If a condition is permanent and degenerative, it is clinically unlikely to improve and may reasonably be expected to deteriorate over time. In these situations, reviews should focus on whether the person’s functional needs, risks, goals, environment, informal supports or equipment requirements have changed, rather than requiring the participant to repeatedly justify that their disability still exists.

This process can be stressful and burdensome for participants and families. It can also create unnecessary administrative cost. Occupational therapy reports and functional assessments require significant time and funding. Where a person’s diagnosis, permanence and functional impact are already well established, repeated reassessment may use funds that could otherwise be directed toward practical supports.

Other systems do not generally require people to re-prove permanent disability every year in the same way. For example, Medicare does not ask people to repeatedly justify the existence of permanent medical conditions each year. The Disability Support Pension also recognises that some disabilities are permanent and should not require repeated re-confirmation unless there is a specific reason to review.

I recommend that participants with clearly permanent or degenerative disabilities have streamlined review pathways. These reviews should focus on changes in function, risk, goals, environment and support needs, rather than repeatedly re-establishing permanent disability.

Functional capacity assessments should reflect real-world function

If functional capacity assessments are introduced or expanded under the Bill, they must reflect real-world function and not assess participants in isolation from the supports, environments and contexts that shape their daily lives.

A participant’s functional capacity is not only determined by their impairment. It is also affected by their home environment, transport access, informal supports, equipment,

Submission 837

fatigue, pain, cognitive load, psychosocial factors, and the demands of the activities they need or want to complete.

For example, a participant may appear to have a certain level of capacity in a controlled assessment environment but function very differently in their actual home, workplace, community or rural property. Occupational therapy assessment must consider how the person performs meaningful activities in context. A functional assessment that removes or minimises environmental and personal context risks producing an inaccurate picture of the participant’s actual support needs.

I recommend that any functional capacity assessment framework under the Bill retains a strong focus on real-world occupational performance and participation.

Streamlining low-cost assistive technology

The current process for low-cost assistive technology can be unnecessarily complex, time-consuming and expensive. In some cases, the cost of the clinical letter, report, quote process, plan manager communication or NDIA submission can exceed the cost of the item itself.

For example, if a participant requires a basic walker, this may be a clinically straightforward and low-risk recommendation. However, depending on the participant’s plan management type and the requirements of the funding body or plan manager, the participant may still need a letter of support, a report, a quote, and additional communication before the equipment can be approved. Where a participant is NDIA managed, the administrative process may be even more time-consuming. This is inefficient and does not represent good value for money.

A more efficient model would be to establish a centralised low-cost assistive technology portal, similar to processes used in other schemes such as DVA. Appropriately qualified clinicians could prescribe common low-risk items from an approved catalogue. This would allow participants to access essential equipment more quickly, reduce report-writing costs, reduce delays, and reduce unnecessary administrative burden.

This type of reform would support the sustainability of the NDIS without reducing necessary supports. It would target inefficiency in the system, rather than reducing participant access to clinically required equipment.

Submission 837

Establishing an NDIS equipment reuse pool

Another practical way to improve sustainability would be to establish or expand an equipment reuse pool for NDIS-funded assistive technology, similar to the SWEP model.

In clinical practice, I have observed situations where participants have unfortunately passed away, leaving numerous equipment items in good working order. In other situations, a participant’s function declines over time and equipment that was previously suitable is no longer appropriate. For example, a participant may initially use a Sara Stedy transfer aid but later require a hoist due to functional decline. The original equipment may still be in good working condition and could potentially meet the needs of another participant.

At present, this equipment may remain unused, be sold privately by families, or be disposed of, despite having significant value. This represents a missed opportunity for the NDIS to reduce costs and improve access to equipment.

A centralised equipment reuse pathway could allow suitable equipment to be collected, cleaned, safety checked, serviced and reissued to participants where clinically appropriate. This would reduce equipment costs, reduce waste, and improve the timeliness of equipment provision.

There would need to be appropriate safeguards. Equipment would need to be assessed for condition, safety, hygiene, suitability and compatibility with the participant’s needs. However, once a suitable item is available through an approved reuse pool, the value for-money assessment would be more straightforward, because the item would already exist and would not need to be purchased new.

This approach could also reduce the cost of clinical reporting. In some cases, where a safe and suitable reused item is available, the clinician’s role could focus on confirming clinical suitability rather than completing extensive value-for-money comparisons across multiple new products.

Sustainability should focus on reducing waste before reducing supports

I support the goal of ensuring the NDIS remains sustainable. However, I am concerned that broad funding reductions, caps or cohort-based approaches risk reducing necessary supports for participants with genuine and significant functional needs.

Submission 837

There are many areas where the NDIS could save money without compromising participant outcomes. These include:

• streamlining access to low-cost and low-risk assistive technology;

• reducing unnecessary repeated assessments for participants with permanent and degenerative disabilities;

• developing an equipment reuse pool;

• improving consistency of decision-making;

• reducing unnecessary administrative processes;

• reducing the need for lengthy reports where the support need is straightforward;

• improving early access to appropriate equipment and home modifications to prevent avoidable deterioration, injury or higher-cost supports later.

In many cases, timely provision of appropriate supports can reduce long-term costs. For example, appropriate assistive technology may reduce falls risk, reduce carer burden, prevent hospital admissions, support independence, delay the need for higher levels of paid support, and reduce the risk of injury to participants and support workers.

A more efficient system should not mean a less individualised system. Sustainability should be achieved by reducing waste and duplication, not by reducing the Scheme’s capacity to respond to individual functional need.

Recommendations

I respectfully recommend that the Committee consider the following:

1. The Bill should preserve individualised planning based on functional capacity, goals, environment, risk, participation needs and informal support context.

2. Funding decisions should not be based primarily on diagnosis, disability cohort or broad support category without individual assessment of functional need.

3. Any Ministerial or Agency powers to reduce, limit or determine funding should include safeguards to ensure participants’ individual functional needs are considered.

4. The principle of participant choice and control should remain central to the Scheme.

5. Reasonable and necessary decisions should continue to reflect the participant’s real-world functional capacity, environment, risks, goals and participation needs.

Submission 837

6. Functional capacity assessments should assess real-world occupational performance and should not remove important environmental, personal and participation context.

7. Participants with clearly permanent or degenerative disabilities should not be required to repeatedly prove the existence of their disability where permanence has already been established.

8. Reviews for participants with permanent disability should focus on changes in function, risk, goals, environment and support needs.

9. A streamlined low-cost assistive technology portal should be established for commonly prescribed, low-risk equipment.

10. The NDIS should establish a national or state-based equipment reuse pool, with appropriate processes for cleaning, servicing, safety checking and clinical matching.

11. Administrative requirements should be proportionate to the cost, risk and complexity of the support requested.

12. The Scheme should prioritise reforms that reduce waste, duplication and unnecessary administrative cost before reducing participant supports.

13. Any legislative reform should be assessed against the original intent of the NDIS, including individualisation, choice and control, participation, and support for people with disability to live ordinary lives.

Conclusion

The NDIS plays a critical role in supporting people with disability to live safely, participate in their communities, pursue goals, maintain independence and reduce reliance on family, carers, hospitals and crisis services.

I support reform that improves sustainability, integrity and value for money. However, I do not support reforms that risk shifting the Scheme away from individualised assessment and toward broad cohort-based funding assumptions. A person’s diagnosis does not determine their functional capacity, support needs, environment, goals or risks. Participants with the same disability may require very different supports depending on their individual circumstances.

In my view, the NDIS can achieve savings through more practical and targeted reforms. These include reducing unnecessary reassessments for permanent disability, streamlining low-cost assistive technology, and reusing equipment that remains safe and clinically appropriate. These changes would reduce waste while preserving the

Submission 837

Scheme’s core principles of choice, control, individualised planning and functional need.

I urge the Committee to ensure that any amendments to the NDIS Act protect the original intent of the Scheme and do not undermine the ability of participants and clinicians to identify supports based on individual circumstances, occupational participation and real-world functional needs.