Supports risk to participant quality of life and provider viability (Individual advocacy)

Submission 845

Executive Summary

welcomes the opportunity to provide a submission to the Senate Inquiry into the proposed reforms included in National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Bill 2026.

’s NDIS division is comprised of 8 organisations, each of which delivers therapeutic, early childhood and/or positive behaviour support services across all states and territories. Across our Disability Services Division we currently support over 17,000 participants and generate positive outcomes for these NDIS participants every day. These capacity building services support long-term independence for participants and reduce escalation into crisis and higher cost supports.

supports the need for Australia to have a disability ecosystem that effectively integrates the NDIS, Foundational Supports and mainstream services to ensure all people with disability maintain essential and capacity building supports, quality of life and effective safeguards. To do so it must have the fully developed and sustainable systems, funding and workforce established across this ecosystem prior to significant budgetary reductions to the NDIS.

We acknowledge the need for significant NDIS reform and the intent to return to its original purpose of support for those with permanent and significant disability. We also acknowledge the degree of urgency to commence these reforms. However, they must be achieved with a balance of improving the total scheme financial cost, improving the efficiency of operation and administration of the NDIA and ensuring the long term viability of the provider market. Fundamentally, without a viable market participants will not have access to the required supports and the scheme may fail.

is concerned these changes are being advanced in the absence of:

• Adequate timeframe to respond: given the substantial and multi-faceted reforms the 2-week timeframe to submit to this inquiry and the subsequent urgency to pass the legislation present a significant risk. As outlined below there are several aspects of the legislation that should be afforded greater scrutiny and consultation for people with disability, providers and the broader disability sector. This risk of rushing this critical phase in the process may have significant and permanent long-term consequences to the viability of the NDIS.

• NDIS Participant and Provider Impact Analysis: the reforms outlined in the legislation and Explanatory Memorandum outline the financial savings to the NDIS as a whole without providing sufficient detail to the impacts to participant quality of life and safety and ongoing sustainability of the provider market.

• Foundational Supports as highlighted by the significant portion of children aged 0-8 accessing the scheme, at present the NDIS has become the primary system of supports for those with disability in Australia which was not its intent. As recommended by the NDIS Review, Foundational Supports represent a key pillar of reform of the NDIS by creating an additional external layer of supports for those who do meet NDIS eligibility.

Submission 845

However, the stated intent to reduce the forecast 2030 participant headcount from 900,000 to 600,000 will require certainty that supports across the broader disability ecosystem are effectively in place and fully operational to ensure no harm or regression occurs to those exiting the scheme. Foundational supports should be centred on the person with disability and be easily identified and accessed.

At present, Foundational Supports do not exist beyond the proposed introduction of Thriving Kids (commencing on October 1, 2026) yet the legislation proposes to commence exiting of participants as of January 1, 2028, leaving a very short timeframe to: o Reach agreements with states and territories beyond the current commitment to invest $6 billion. o Determine the broader national foundational support model that has capacity to support the diverse range of disabilities and functional impairments required. o Allow states to adapt this national model to state-based implementation plans. o Have states commission and implement the programs and services. o Measure the effectiveness of these supports to ensure no participant exiting the NDIS is at risk of harm or a reduction in quality of life.

• Mainstream services: the Explanatory Memorandum for proposed legislation does not adequately model the likely downstream demand and costs to hospitals, urgent care clinics, mental health systems, homelessness services, education systems and aged care systems. In advance of the legislation being passed there should be quantifiable demonstration of this anticipated increased demand to ensure these systems have the capacity to absorb such pressures.

As such, while the NDIS reforms are necessary, the current proposed legislation and timeframes raise significant concern about the risk it poses to participant safeguards and quality of life and ongoing provider viability. It is critical that the reforms are measured in terms of costs and cost benefits across the whole disability ecosystem and not a cost shift from the NDIS to other elements and that they have adequate time to be effectively implemented and measured.

Access and Eligibility

Functional Capacity and Assessment

Consideration

supports the overall intent to shift access and eligibility determinations for the NDIS from diagnosis and access lists to a focus on functional capacity. However, the shift does not need to be exclusive as a more effective approach would have the proposed functional assessment as the primary tool that is supported by the diagnosis, relevant medical information and other evidence available regarding the applicant or participant.

The NDIS Review recommended that assessment processes allow for evidence from a range of sources, including treating professionals. The legislation, combined with Support Needs Assessment as part of the New Planning Framework, may reduce or exclude the role of participant-provided disability and allied health evidence when these items could be included to inform a more accurate and reliable assessment of NDIS eligibility.

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Submission 845

Additionally, the legislation outlines that the new definition of functional capacity assesses what a person can do:

• Without assistance from other people.
• Without assistive technology or modifications.
• Excluding, as far as possible, environmental and personal circumstances.

However, the World Health Organization’s International Classification of Functioning, Disability and Health

(ICF) recognise that disability arises through the interaction between:

• Impairments
• Environmental factors
• Participation barriers
• Support systems
• Personal circumstances As such, access and eligibility assessments that do not consider environmental, social, cultural, geographical, financial, and relational factors risk creating an inaccurate assessment of disability and support need and potentially inappropriate exclusion of individuals from scheme access.

Recommendation: While acknowledging the intent to establish a Technical Advisory Group, given the central role of functional capacity assessments, impairment categories and thresholds to the legislation and reforms, the absence of procedural detail prior to passing of the proposed legislation represents a significant consultation gap.

The following questions are not effectively clarified by the Explanatory Memorandum and should be addressed prior to passage of the legislation:

• How functional capacity assessments will be linked to impairment categories?

• How thresholds will be established and how they will be adapted to the diverse range and severity of impairments?

• How the point in time assessments will address when participants who have fluctuating severity, present inconsistently, or mask disability impacts during formal assessments?

• How existing evidence held by, or provided to, the Agency will be used?

• Whether categorisation will be based on clinical judgement, administrative guidance, or algorithmic systems?

• How consistency across assessors, delegates and regions will be ensured?

• Is there potential and unnecessary duplication of assessment processes between this Access and

Eligibility Functional Capacity Assessment and the Support Needs Assessment for New Framework

Planning?

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Submission 845

Impairment

Consideration: acknowledge the NDIS should be responsible for providing supports linked to the accepted impairment(s). We also acknowledge that applicants or participants may also have additional impairments that separately do not meet eligibility requirements.

As such, whereby the additional impairment has no intersectionality to the accepted impairment we accept supports should not be the responsibility of the NDIS and should be provided by other parts of the disability ecosystem.

However, where cumulative and/or intersecting impairments exist then the interactive effects of multiple impairments may be underestimated, and support needs that cannot be neatly attributed to a recognised impairment may be excluded.

Additionally, the proposed support needs assessment tool- ICAN- is used to capture support needs in a broad, holistic manner, but if funding must ultimately be allocated only to recognised impairment categories or functional domains, the integrity of the comprehensive assessment risks being compromised.

Recommendation: This inquiry should consider the impact of the proposed legislation regarding:

• How holistic functional capacity and support needs assessments can be reconciled with specific impairment-based eligibility and funding allocation models?

• Whether safeguards will preserve the integrity of comprehensive assessment?

• How urgent or significant support needs arising from interacting impairments will be addressed? Permanence and “Appropriate Treatment”

Consideration: The legislation introduces a significantly stricter permanence test requiring participants to undertake “all appropriate treatment” before impairments may be considered permanent. It indicates that treatment may still be considered “appropriate” regardless of:

• Financial barriers.

• Geographical location.

• Participant’s capacity to access treatment. In doing so there is an increased risk of discriminatory inequity based on to:

• Inaccessible healthcare systems.

• Lack of available specialists.

• Workforce shortages.

• Transport barriers.

• Socioeconomic barriers. Page 4 of 9

Submission 845

This approach appears contradictory to the introduction of Access and Eligibility Functional Capacity Assessment and Support Needs Assessments which have, as part of their intent, creation of a more equitable system for those without access to services or financial means to obtain additional information.

Clarification also needs to be made between the legislations interpretation of ‘treatment’ and Capacity Building supports. Capacity building supports are intended to be part of the NDIS response to disability rather than a prerequisite for entry and may shift responsibility for functional improvement onto the individual before access is granted.

Recommendation:

1. Determination of permanence should not discriminate against those without access to appropriate treatment as outlined above.

2. Clear definitions of ‘treatment’ and ‘Capacity Building Supports’ should be provided to clarify the connection of each to the definition of permanence.

Plan Funding

Plan Reassessments

Consideration: acknowledges the intent to reduce the volume of unscheduled plan reassessments. The concerns we have with respect to this is:

• extending decision timeframes from 21 days to 90 days as it does not align with tightened criteria of requiring significant change in circumstance which often creates an urgent safety and wellbeing risk but deferring the response time.

• It fails to consider current flaws in creation of plan budgets. Plan reassessments currently result in an approximately 20% uplift in plan funding and outcomes of Administrative Review Tribunal decisions result in an almost 80% rate of plan amendments thus indicating systemic flaws in the setting of plan budgets.

Recommendation:

• If, as indicated, these changes result in a 50% reduction in unplanned plan reassessment volume there should be sufficient capacity to maintain the current 21-day timeframe. In doing so addresses the risk of urgent reassessments being overlooked or delayed..

• Further evidence and analysis should be provided to demonstrate that the setting of budgets is effective in meeting the support needs of participants. The combined impacts of all legislative and process changes, including New Framework Planning, remain untested and unknown which may heighten the demand for unscheduled plan reassessments not reduce it.

Reasonable and necessary supports

Consideration: acknowledges the changes to definition and application of ‘reasonable and necessary supports’ including:

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Submission 845

• Refining what it means for a support to be reasonable by deciding what is reasonable to expect the NDIS to fund as a whole beyond just the individual participant support needs as per current arrangements. The NDIS has been founded on setting of individual plans and budgets which allows for the diversity and severity of impairments. However, this approach allows scheme budgetary caps to be imposed which has the potential to undermine the scheme, the safety of participants and viability of the provider market.

• Creating consistency across government-funded social service systems. While it is reasonable to aspire to such consistency the variability in the nature and complexity of the schemes must be considered to ensure a fair comparison.

• Specifying a maximum amount of funding supports, maximum intensity for provision of support or a maximum ratio of worker to participant for provision of supports for a participant or groups of participants. The Explanatory Memorandum provides limited detail as to how maximums would be determined and applied. The legislation must include the need for transparency for evidence-based methodology and ultimately visibility of any maximum thresholds that are established.

Recommendation:

1. Effective reform of the scheme should ensure it operates at efficiency and enable confidence that supports for participants are justified. Subsequently there should be minimal, or no, need to establish budgetary caps for the scheme as a whole.

2. When benchmarking against similar schemes appropriate consideration should be given to key differences in the purpose of the scheme, the financial sustainability of the scheme, the variability of participant requirements and the impact on provider viability.

3. Ensure visibility and transparency when setting maximum amounts of supports, intensity or ratio of workers.

Funding resets

Consideration: understands the legislation may enable the Minister to reset funding for whole groups of supports across all participants receiving funding under those groups. As a provider of Capacity Building supports we acknowledge the intent for a 10% reduction in budgets commencing with reassessed or renewed plans from October 1, 2026.

The Explanatory Memorandum does not effectively demonstrate the rationale and methodology for how this figure was determined and the forecast impacts on the scheme financial performance or participant outcomes.

Unlike Core Supports, Capacity Building supports are those that are designed to increase the function of the participant to both improve quality of life and reduce the burden on other systems such as health, education and aged care. Yet there is no objective evidence provided as to the cost benefit in reducing funding to capacity building supports.

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Submission 845

Recommendation: Release of detailed financial modelling to justify this proposed reduction including a more detailed impact analysis on participant functional outcomes and burden to other support systems.

Plan renewals Consideration: acknowledges the shift to a ‘plan renewal’ process in place of the current plan rollover process. We support this change as it creates greater certainty of renewal dates and plan continuity.

However, it potentially exacerbates the current significant issue for providers of lack of plan and budget visibility. Participants are not obligated to provide plan or budget information which results in providers being highly exposed in knowing, with certainty, the amount of available funding. This results in considerable financial exposure and frequent cost write-offs.

Recommendation: With the introduction of improved use of automation, and therefore system updates there should be capacity for providers to confirm funding is available and quarantine the required amounts. This will ensure providers can have confidence that the participant has available funds or there is no risk of funds being used by another provider.

Pricing Powers

Consideration: acknowledges and supports the intent to shift decision making on pricing to the relevant Minister.

Recommendation: In doing so, we would support a shift to an independent pricing body, such as IHACPA, overseeing pricing regulation. While acknowledging the need for long-term scheme financial sustainability the mechanisms to do so must ensure provider viability, in particular with respect to pricing models. Pricing structures cannot simply compare rates charged in various schemes but must also consider the differences in scheme complexity in delivering effective and safe supports.

Automation

Consideration: recognises the intent for the legislation to authorise automated administrative actions and decision-making,. We recognise that automation can assist -administrative processes and result in significant efficiency and cost reductions. However, there are serious risks if automated systems are used in:

• Access and eligibility functional capacity assessments and decision making.
• Reassessment determinations.
• Support needs determination and funding allocation. Page 7 of 9

Submission 845

Disability assessment requires clinical judgement and understanding of context; communication; trauma; culture; and fluctuating presentation. As such any use of automation within assessment processes must be used solely as an administrative support and not where discretion and evaluative judgement are required.

Recommendations: recommends that automated processes should have:

• Strict limits on levels of automation.
• Mandatory human reviews for tasks requiring decision making.
• Prohibition on fully automated eligibility or funding decisions.
• Transparency regarding algorithms and rules.
• Independent oversight mechanisms.

Conclusion

urges the Committee to recommend:

• Delaying and amending the legislation pending more comprehensive consultation and impact assessments.

• Ensuring foundational supports exist and are adequately funded before restricting NDIS access.

• Retaining environmental and personal factors within functional capacity assessments.

• Retaining individualised funding approaches by removing or limiting Ministerial powers to impose broad funding cuts.

• Prohibiting fully, and safeguarding partially, automated eligibility and planning decisions.

• Protecting community participation and capacity building supports. . urges the Committee to ensure that reforms balance:

• Cost Savings: ensure cost savings are obtained in ways that minimise the impact and harm on participants and their support networks and maintain viability of the providers of support

• Cost Impacts: ensure that cost impacts are accurate and reliable. This includes both stated savings but also downstream impacts on other areas of the disability ecosystem. Costs should be reported across the whole of this ecosystem to effectively demonstrate all aspects of the cost impact of disability supports

• Cost Benefits: most significantly, discussion around legislative reform of the NDIS has focussed solely of the cost of the scheme as a whole. There has been insufficient analysis and reporting on the significant cost benefit of the scheme to the economy, to the workforce engaged but most significantly the hundreds and thousands of participants who benefit significantly every single day. It is critical that governments at all levels collaborate to better measure these benefits across a range of metrics. In doing so the ‘social licence’ of the NDIS will be restored to its rightful place.

As a large registered national provider of supports remains committed to the success and sustainability of the NDIS and stands ready to contribute constructively to legislation and reform co-design processes that improve safeguarding, funding precision, participant outcomes, Scheme administration, and long-term public value

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Submission 845

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