The latest changes to the National Disability Insurance Scheme (NDIS) have sparked heated debate. While the government says the changes are about improvements to clarity and efficiency, the reality is they bring both positive and negative impacts for participants.
There’s a lot to unpack and I’m not going to be able to cover it all. I’ll try to work through what I consider to be the most important items.
I should state a couple of things up-front. Firstly, I am a NDIS participant. Secondly, I think these changes are necessary for the longer-term survival of the NDIS. This is probably an unpopular opinion. Are they perfect? No. Should there have been more community consultation? Yes, absolutely. But something needs to change. I think on balance, this is a step in the right direction.
Reasonable and necessary supports and support lists: Getting it right matters
Since its inception, the NDIS has faced challenges related to inconsistent interpretations of what “reasonable and necessary” supports are.
So, what does ‘Reasonable and Necessary Supports’ actually mean?
Let’s start with a bit of context. According to the NDIS Act, for a support to be considered “reasonable and necessary,” it needs to meet six criteria:
- Be related to the participant’s disability.
- Not include day-to-day living costs (unless those costs are directly attributable to the participant’s disability).
- Be effective and beneficial for the participant.
- Consider informal supports (like help from family and friends).
- Be value for money.
- Take into account any relevant community, mainstream, or other government services already available.
That’s a lot to keep track of. But really, it’s about ensuring that the NDIS funds things that directly support a person’s disability needs and helps them achieve their goals, while also being cost-effective and coordinated with other services and supports.
The problem? These criteria, while logical, are open to a huge range of interpretations. What’s “beneficial” to one might seem unnecessary to another. What’s “value for money” might depend on whether you’re looking at short-term costs or long-term outcomes. And while the scheme aims to be holistic, the lack of clarity has created an environment where decisions can seem arbitrary and inconsistent.
The new legislation, the ‘Getting the NDIS Back on Track No. 1 Bill 2024′, according to the Government aims to tackle these issues by defining what NDIS funds can be used for by establishing specific lists of approved supports.
‘Support lists’ have technically existed in NDIS since day one, but with much less structure and definition. Previously, the concept of support categories like Core Supports, Capital Supports, and Capacity Building were used to broadly guide funding decisions. However, the specifics of what was covered under these categories were left largely to the discretion of individual planners and decision-makers.
The new changes create more explicit and detailed support lists, which are now structured catalogues. They define the types of services and items the NDIS considers “reasonable and necessary”.
In essence, support lists serve as a guide to help participants, planners, and service providers understand what’s typically covered, and, more importantly, what isn’t covered.
They’re specifying exactly what NDIS funding can and can’t be used for. They say the clearer guidelines are designed to reduce ambiguity for both participants and providers. This will ensure that funding is directed effectively and transparently.
If you ask me, this is long overdue. This has been an area of confusion that has plagued participants, myself included, and led to disputes and/or misuse of funds or denial of services.
The substitution rule: Getting the right support when things change
A ‘substitution rule’ has also been introduced. It allows participants to substitute one support with another, provided certain criteria are met. Specifically, this rule provides a way to fund non-standard supports, something which is now harder to do as a result of the changes. It’s a bit like being able to swap ingredients in a recipe. You get the same dish at the end, but you can tailor it to your tastes and needs.
For example, let’s say you were originally funded for a physiotherapy program, but your needs change and you need occupational therapy instead. Previously, making this change could involve a lengthy review process and possibly a new plan altogether. Under the Substitution Rule, the theory is you can request the change more seamlessly, provided the new support fits within your existing budget and plan framework.
Sounds great, right? Yes, but, the NDIS doesn’t just let participants swap supports whenever they want. Here’s what needs to happen for the substitution to be approved:
The support is of equivalent cost
The new support must be the same cost or less than the original. I’d imagine this is to stop the ‘one price for NDIS and another price for everyone else’ issue that the government talks about. It keeps your overall budget intact and ensures there’s no impact on your broader plan.
It must deliver similar or better outcomes
The key factor here is that the substituted support should meet your goals and objectives as effectively or even better than the original. No changes for change’s sake. it’s about achieving the best possible outcome for participants.
It’s a like-for-like replacement
The substitution must replace a similar type of support. For example, swapping out one type of therapy for another is fine. But swapping therapy for transportation services isn’t unless it’s justified by a significant change in circumstances.
Documentation is still required, but simplified
We’ll still need to provide some documentation (this is a government program after all). But it’s more about showing how the substitute support meets your needs rather than making a whole new case from scratch.
More explicit and structured support lists, combined with the introduction of Impairment notices (see below), make it more difficult to have non-standard supports funded by the NDIS. The introduction of the substitution rule means that while it is more difficult, it is still possible. Though, I’ll be interested to see how (and if) the substitution rule works in practical terms. If reasonable requests for substitutions are granted, great. But if not, then participants may be left with supports that don’t meet their needs.
Impairment notices, WTF!
One of the more significant additions is the concept of ‘impairment notices’. This change is intended to bring more clarity and structure to the scheme, but it raises questions about its implementation and impact on participants.
What are impairment notices?
Impairment notices are formal written notifications issued by the NDIS to participants as soon as they become participants, or if a specific circumstance arises that affects their status. The notices outline the categories of impairments participants have that qualify them for NDIS support. This aligns these with the “disability requirements” or “early intervention requirements” specified under the NDIS Act.
The impairment notice will clearly state:
1. Categories of impairments
The notice will include detailed information on the types of impairments a participant has that are recognised by the NDIS. These could be:
- Intellectual impairments
- Cognitive impairments
- Neurological impairments
- Sensory impairments
- Physical impairments
- Impairments linked to psychosocial disabilities
2. Early intervention notices
If the participant qualifies for early intervention support, the notice will also specify this, using categories defined under the new regulations. For participants with developmental delay, the notice will clearly state this as the primary category.
3. Purpose of the notice:
The aim of the impairment notice is to serve as a baseline for participants to understand the scope of support they are eligible for, based on the NDIS’s criteria. It’s a way of formally documenting the categories of impairments that justify the inclusion of a participant in the scheme. In theory, this creates a clearer, more transparent starting point for developing and updating support plans.
4. Updating or varying notices:
The NDIS CEO has the authority to update or vary these notices if new information comes to light or if the participant requests a review. This flexibility is designed to accommodate changes in a participant’s condition or new medical evidence that may influence their categorisation.
As strange as this might sound, I’m cautiously optimistic about the general concept. I mean, if it works, then the impairment notice means that participants are aware of what they’re entitled to. This will reduce misunderstandings and help them plan their support needs more effectively.
And that has to be a good thing, right?!
Strengthening the NDIS’s foundation for the future
There are also changes to funding allocations, eligibility reassessments, and the introduction of a structured claims and payments framework.
For me, these reforms are not just about tightening control. They also aim to future-proof the NDIS and make the scheme more robust.
The NDIS is a lifeline for many Australians. Its survival depends on maintaining a delicate balance between flexibility and sustainability. These reforms are a step in that direction. While some participants may experience short-term disruptions, my hope is that the long-term benefit will be a more consistent and transparent system that can support future generations.
We need to make sure the NDIS can continue to provide high-quality supports for those who need them. With clearer rules, better oversight, and a stronger foundation, the scheme is being reformed. Hopefully, throughout all the change, it stays true to its original purpose while also adapting to new realities.
To explore the details of these changes, you can view:
