The Provider Loft

Supporting small and medium NDIS and health providers in Australia

David Kinnane

In deep water: paediatric allied health NDIS providers should read the Grattan Report

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The Big Picture:

On 29 June 2025, the influential Grattan Institute published a 108-page report with proposals to save the NDIS (link below).

Many allied health providers were distracted by financial year-end and compliance tasks to comply with the (now live) Pricing Limits for 2025-26.

But the report is well worth a read – particularly for paediatric allied health providers who own or work out of clinics.

Attention-grabbers:

The report authors, led by former NDIA senior policy advisor Dr Sam Bennett, propose several very significant changes:

  • Abolish the early intervention pathway (i.e. section 25 of the NDIS Act) (pp57, 83).
  • Abolish individualised funding for all children under 18 who are or would have otherwise been supported through the early intervention pathway (pp31, 57).
  • Redirect funds to replace the early intervention pathway with “muscular” Foundational Supports (pp56-59):
    • general supports: information and education; and
    • targeted supports, including “low-to-mid-level allied health supports to improve the long-term capabilities of children” (p13).
  • Governments to co-commission Foundational Supports:
    • with 3-5 year contracts (pp49, 71), including for “evidence-based services” to “encourage providers to offer higher-quality programs” (p57); and
    • from “lead providers” that have the capacity and systems to manage a group of sub-contractors (pp50, 73).
  • Adopt a Key Worker model to help families navigate options (p54).
  • 5-year transition to avoid service gaps and give providers “sufficient time to prepare” but with the transition to start from 1 July 2026 (p60).
  • All Foundational Supports – and thus all early intervention therapies – for children to be delivered in natural environments – not clinics – including in “supported playgroups, early childhood education settings, health and community hubs, libraries, and family- and community-led organisations” (pp30, 57).
  • No mandatory registration of allied health providers to provide Foundational Supports. Recognition of AHPRA registration/regulation by a professional body (p75).
  • Better national sharing of provider information, and better integration of provider registration and worker screening checks (pp75-76).
  • Retain individualised plan funding for children with lifelong and severe disability (i.e. for children who meet the disability requirements under s 24 of the NDIS Act) (p57).

Reality check:

These are proposals from a think tank – not government policies. But the report is well-researched and written, and is likely to get the attention of policy decision-makers, as well as media and social media critics of the NDIS.

Bottom line:

Participant and disability advocacy groups will have a lot more to say about the report and the implications for access, and for choice and control over allied health early intervention services.

But paediatric allied health providers should also consider the report when reviewing their business strategies and risks for 2025-26 and beyond.

If implemented, the Grattan proposals would:

  • transform early intervention allied health service-delivery across Australia; and
  • accelerate the sector-wide shake-out of paediatric allied health service providers.

Go deeper:

Bennett, S., Jessurun, M., and Orban, H. (2025). Saving the NDIS: How to rebalance disability services to get better results. Grattan Institute.

Sector on edge: the NDIA knows it needs better processes to reduce NDIS reform anxiety and to rebuild trust with participants and providers

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“Implementation [of reforms] does not stop with how our service delivery staff put that in a plan. Providers also have to know the consequences, know what to do, know what participants will come to them and ask about, and be able to support them” – NDIA staff member* 

Big picture:

The NDIS reforms of 3 October 2024 were not well-implemented or communicated to participants or providers. A new report reveals NDIA management knows about some of the things that went wrong internally. But will they learn from their mistakes, and listen to participants and providers?

Report: 

On 23 June 2025, the NDIA’s Policy, Evidence and Practice Leadership Division published a report with its “early observations” on the NDIA’s initial implementation of NDIS Act amendments that took effect on 3 October 2024, including:

  • section 10 and its accompanying transitional rules defining NDIS Supports (containing the “in list” and “out list”); and
  • section 33 (funding amounts, periods and components).

Context:

The “in and out” lists were finalised on 2 October 2024 and implemented on 3 October 2024 (p 8) after what can be described (charitably) as a very limited consultation period. Many stakeholders were dissatisfied with the consultation timeframes (p14). After the reforms went live, NDIA staff, participant, planner, and provider confusion ensued over interpretation of the lists.

Cases in point:

For example, some participants and providers were confused about:

  • whether funding for food and transport (both on the “out list”) were permissible in relation to short-term accommodation (p13);
  • whether the use of tablets (on the “out list”) embedded in assistive communication devices (on the “in list”) were okay (p24);
  • what, exactly, was meant by the term ‘evidence-based therapeutic support’ (p24); and
  • whether therapy types that were not on the in or out lists were okay (e.g. for chiropractic therapies) (p25). 

What went wrong:

Among other things, the report authors observed that:

  • the amendments generated participant uncertainty and anxiety (p6);
  • months of planning proved inadequate, and initial implementation of the changes was more challenging than expected (p26);
  • NDIA staff weren’t ready or adequately trained to answer some specific stakeholder questions with confidence (pp6-7, 25), including gaps in knowledge and skills needed to apply the changes to “nuanced circumstances” (i.e. beyond generic answers) (pp20, 27). To quote an NDIA staff member: “We had to do our first participant information session on the changes on the afternoon of 3 October and we were still trying to understand the changes ourselves” (p27); 
  • the NDIA had to publish around 50 clarifications (p7) and felt some of their clarifications and corrections were drowned out by social media commentary (p13);
  • problem resolution was stymied by inadequately coordinated internal communications across the NDIA (p7); 
  • some NDIA staff were unaware when previous guidance and FAQs had been superseded (p 25); and
  • some plan managers and providers responded by taking a “risk averse” approach to the “out list”, and erred “on the side of caution” (p8), which may not have been anticipated by the NDIA.

Lessons learned?

The report authors make some sensible suggestions for future reforms, mainly focused on improving internal processes. But stakeholders weren’t overlooked, with recommendations that included:

  • recognising that the pace of change may not be sustainable, given its potential impacts on stakeholders, participants and the disability community and “for ensuring continued collaboration and quality outcomes” (p31);
  • involving participants and sector stakeholders in the planning process to identify potential issues (p32);
  • more emphasis on participant communication and engagement before changes take effect (p31);
  • the importance of prepared resources and clear communication in place before reforms take effect (p31); and
  • the need to consider “unintended consequences” (secondary effects) of flurries of clarifications from the NDIA post-reforms, e.g. on participant and other stakeholder anxiety levels (p31).

Why this matters now: 

  • Since the October 2024 reforms, stakeholder relationships have been further strained by the 2025-2026 NDIS Pricing Arrangements and Price Limits that take effect on 1 July 2025. 
  • Section 33-empowered changes to funding periods are now being implemented, including 1, 3 and 12 month periods, affecting participants (and providers who must design systems to comply with changes). 
  • The next major round of reforms are upon us, including:

Bottom line:

The NDIA knows it needs to maintain strong relationships with the disability community because they are “essential for the ongoing success of the reform program” (p31). It also knows that providers have to understand the rules before we can build systems to comply with them and to support the participants we serve (p28). Good internal processes and clear communication from the NDIA will play a big part in determining the outcomes of the next tranche of reforms and  public confidence in the scheme. 

Go deeper:

Full report (very difficult to search for, and find, on the NDIA website):

NDIA (Policy, Evidence and Practice Leadership Division), The Introduction of defined NDIS supports, funding amounts, funding periods and funding components – Early observations on implementation, Version 1.0 – June 2025.

Consultation on NDIS Supports rules

NDIS Evidence Advisory Committee

*quote, from p28 of the report.

Allied health providers and pricing controls: independent providers that employ, train, and supervise staff are caught in the middle, and might not survive (and the NDIA knows it)

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Calm, measured, and constructive: my mantra as I sat down to read the Final Pricing Report: 2025 of the Independent Pricing Committee (IPC) (released on 11 June). I wanted to understand why things seem so bleak for so many independent allied health providers right now. Here’s what I learned (including report page references so you can check for yourself):  

A. Recent pricing cap freezes were designed explicitly to put downward pressure on prices. But they haven’t worked and are beginning to put the ongoing viability of some providers at risk (p 32).

B. Six years of frozen pricing limits have forced the provider market to split into three sub-markets (p 42):

  1. Sole clinicians/traders with no staff and minimal overheads/costs.
  2. Large volume providers, often backed by investors and strong balance sheets, who can operate efficiently at scale.
  3. Specialised and clinically-oriented providers who “employ staff and have [compared to sole traders] more overheads associated with clinical governance, oversight and supervision, and undertake more training and development of staff” (p39).   

C. In theory, pricing controls should not be used to favour or punish any type of provider: Pricing arrangements should not be used to favour or target any particular organisational or operational model (p 9). The IPC is “not suggesting the [NDIA] should be targeting any one market structure with respect to the contributions of small versus large providers, for-profit versus not-for-profit providers, or registered versus unregistered providers” (p 44).  

D. In practice, the IPC and the NDIA know that pricing controls are punishing smaller independent clinics that employ, train, supervise, and employ staff: “The financial viability of these service providers may be put at risk under singular time-based price caps. These alternative organisational delivery models can also be expected to struggle to attract resources (practitioners, administrative stage, investors) further challenging their ongoing viability” (p 39-40).

E. Why this matters:

Therapy supports play a crucial role in achieving the NDIS’s objectives. More than 60% of participants use therapy supports (p 62-63).  

The structure of the provider market determines participant choice and control: “If the Scheme’s objective is to ensure the availability of a wide mix of reasonable and necessary supports – and the availability of those supports depends on the supply-side of the market – and the structure of the supply side of the market depends on the structure of administered price caps, then the approach to setting those prices must be guided by the objective of promoting a market structure that supports the availability of a wide mix of services” (pp 43-44). 

Ultimately, participants care about much more than price: Geographic proximity, rapport with the therapist, therapist reliability and openness, the reputation of  the provider and the therapist matter more to participants than price (pp 5, 38).

With current policy settings, independent clinic owners who employ staff may have no option but to downsize and/or exit the NDIS, reducing both competition for remaining providers, and participant choice and control. This is because independent clinics can’t compete for much longer with:

  1. large volume providers who “will be able to attract practitioners with terms and conditions of work that smaller providers, or providers or more varied and complicated services may find difficult to match” (p40) and can afford to trade through periods of declining profitability because of the “growth in the balance sheet of many providers” and by “drawing upon their stronger asset base to meet cash flow challenges” (pp 33-34); and
  2. sole traders who can deliver base services with very minimal overheads (because they don’t need to invest in physical clinics, or train or supervise staff) (p 39). 

F. Limitations: The report is limited to pricing and makes no recommendations (pp 11, 18). The IPC admits that provider consultation was limited “to avoid duplication and additional burden on providers given the short time that was available to the IPC to consult” (p 20). Consistent with the Annual Pricing Review, it posits a differential pricing framework of some kind to distinguish different types of services, including (undefined) standard and higher value services (p 7-8). It also suggests reforms to increase price and service transparency (e.g. a price comparator and a “digital supermarket” of providers) (p 9-10).

G. Were independent clinic owners heard? The reference list at the back of the report is skewed notably toward larger providers (pp 96 et seq.), which might explain why the IPC’s reporting of “provider submissions” reflect, in the main, the position of large registered providers (e.g. pp 33-34, 65-66). 

Bottom line:

NDIS participants – rightly – value choice and control over the allied health providers and therapists they work with. Participants choose providers for lots of reasons other than price. We hope there is a future for viable independent clinics to provide personalised, high quality services to participants and to employ, train and supervise the next generation of therapists. But, right now, I wouldn’t bank on it.

Read more: Independent Pricing Committee – Final Pricing Report: 2025

Divided we fall: provider vs. provider, and the unbundling of allied health provider NDIS therapy services 

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The big picture:

The 2024-2025 Annual Pricing Review, released by the NDIA on 11 June 2025, is full of bad news for allied health providers and the participants we serve. Most commentary so far has focused – quite rightly – on the most imminent price limit cuts for physiotherapists, dietitians, and podiatrists, as well the tough pricing limits for allied health provider travel. But there’s a lot more in the review to think about.    

The bigger picture:

The NDIA has abandoned the idea of a flat hourly NDIS price limit for allied health therapies, deeming it “no longer necessary to facilitate market expansion” (p12). It has signalled it will move toward:

  • a differentiated pricing approach (pp13, 88); and
  • an unbundling of some allied health services to provide greater transparency and oversight of allied health therapy services/activities (pp82-84).  

Market context:

In the six months to December 2024: 

  • more than 55,000 allied health providers provided NDIS services to almost 413,000 participants;
  • total allied health therapy payments reached $2.4 billion; and
  • five types of therapies accounted for more than 75% of therapy payments: occupational therapy, early childhood, behaviour support, speech pathology, and physiotherapy (pp51-54). 

Dual market structure:

There is a growing schism in the market for NDIS allied health therapy services:

  • Registered: About 10% of providers are registered, and make up about 62% of total payments. (The top 10 registered providers have a total market share of around 10.5% – p57-58.) Registered providers tend to operate at scale. 
  • Unregistered: About 90% of therapy providers are unregistered and make up about 38% of total NDIS payments. Unregistered providers tend to be small businesses, with “flexible business models and lower administrative overheads” (p56).  

Why it matters:

The NDIA recognises that differences in provider scale, cost structure and administrative capacity will influence providers’ responses to price limits (p61). In various parts of the review, the NDIA appears to:

  • contrast “small-scale, low overhead unregistered providers” with “a small number of larger registered providers with greater infrastructure and clinical governance capabilities” (p 11);
  • suggest that the diversity of business models across the sector “highlights emerging challenges with the alignment between current price limits and they way therapy supports are being delivered in practice” (p13);  
  • opine the registered providers “represent a relatively stable base” (p63); and
  • conclude that its ongoing therapy review pricing should consider factors like “practitioner qualifications, workforce availability, service settings, regulatory obligations  and the nature of participant outcomes achieved” (p88).

Unbundling therapy services:

NDIS therapy supports currently include direct face-to-face time as well as indirect participant-related planning, clinical communication, documentation, resource creation and travel (p82-83). The NDIA thinks this “bundling” makes it difficult to determine whether providers are being efficient. It recommends: 

  • “unbundling” provider travel for therapy supports (with effect) from 1 July 2025 (p83); 
  • exploring whether to impose new price limits and other guidance on report-writing arrangements (p84); and
  • closer scrutiny on session lengths and visibility of what is delivered in each session (p.86). (This appears to underpin the recommendations about presenting therapy support price limits in 10-minute increments (p16)). 

What we’re watching:

  • Future pricing limit reforms: In addition to different pricing limits for different kinds of therapies, we may end up with different pricing limits for different provider types (e.g. registered, unregistered), support complexity and delivery settings (p87).  
  • Further ‘unbundling’ of therapy support services: The NDIA may seek more granular oversight of therapy supports to increase its visibility over different components of our services (p 86).
  • Interaction with other reforms: Further pricing limit reforms are likely to be affected by mandatory registration proposals (and vice versa), including the still-open question of whether AHPRA registration and professional self-regulation of allied health professionals will satisfy NDIS registration requirements (in whole or in part). 

Read more:

2024-2025 Annual Pricing Review

NDIS access denied: even without the reforms, things are getting tougher for NDIS applicants

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The big picture:

A recent Administrative Review Tribunal (Tribunal) decision in Sydney suggests that it’s getting harder for applicants to meet the disability access criteria to become an NDIS participant. 

Context:

To get access to the NDIS, applicants must meet a number of disability-related tests under section 24 of the NDIS Act. Among other things, they must prove:

  • they have a disability attributable to one or more intellectual, cognitive, neurological, sensory or physical impairments, or one or more impairments to which a psychosocial disability is attributable;
  • the impairment(s)are likely to be permanent; and
  • the impairment(s) result in substantially reduced functional capacity to undertake one or more of the following activities: (i) communication; (ii) social interaction (iii) learning; (iv) mobility; (v) self-care; (vi) self-management (the “six activity areas”).

Case in Point: 

  • In a decision published on 26 May 2025, the Tribunal took a close look at the meaning of “substantially reduced functional capacity” in each of the six activity areas. 
  • There was no doubt that the applicant lived (and lives) with a permanent disability arising from impairments that reduce her capacity to perform life activities.
  • But the Tribunal decided the applicant’s impairments did not result in substantially reduced functional capacity in any of the six activity areas. This means the applicant did not qualify for access. 

Zoom in:

The Tribunal’s decision was striking for a number of reasons. The Tribunal decided that: 

  • Rule 5.8 of the National Disability Insurance Scheme (Becoming a Participant) Rules 2013* deems some applicants to have met the “substantially reduced functional capacity” test – but it is not exhaustive. If the applicant isn’t deemed to satisfy the test by Rule 5.8, the Tribunal must make the decision based on statutory interpretation;
  • NDIS disability access requirements should be interpreted and applied in conformity with the World Health Organisation (WHO) International Classification of Functioning, Disability, and Health (the ICF);
  • the WHO Disability Assessment Schedule (WHODAS 2.0), a standardised method for measuring health and disability under the ICF, is a helpful analytical framework to give meaning of “substantially reduced function”; 
  • “substantially” means more than “moderate”, and interpreted this to mean more than 50% reduced functional capacity to perform the activity;
  • “reduced” should be understood as being one or more of four ways specified as difficulty factors under the WHODAS 2.0, namely (i) increased effort; (ii) discomfort or pain; (iii) slowness; and (iv) changes in the way a person does the activity; and  
  • an assessment of reduced capacity in one of the six activity areas:
    • should ignore environmental factors that affect performance (rather the capacity), e.g. a lack of local transport options or other services;
    • should not be measured against an earlier stage of life or someone who has prowess at the activity; but 
    • should be measured relative to a person who does not have the applicant’s impairments according to an objective standard of a level of basic function “consistent with day-to-day subsistence”.

Friction Points:

Perhaps most controversially, the Tribunal held that as a matter of statutory interpretation, domestic tasks such as laundry, domestic cleaning, gardening and maintenance, do not fall within any of the six activity areas. This is a marked departure from several previous Tribunal decisions, in which the decision-maker has concluded that such tasks fall within mobility, self-care and/or self-management activities. (The Tribunal decided that tasks within the self-management activity area are limited to cognitive tasks associated with personal organisation, planning, decision-making, self-care, problem solving and financial management.)

On the facts:

The Tribunal decided the applicant’s reduced functional capacity for communication, social interaction, learning, mobility, self-care, and self-management were not substantially reduced. As such, the applicant did not get access to the NDIS. 

Yes, but:

Arguably, parts of the Tribunal’s statutory interpretation in this case do not sit easily with parts of the Federal Court’s 2023 decision in Foster. As noted, the Tribunal’s comments on domestic tasks are inconsistent with several previous Tribunal and AAT decisions. For applicants and the NDIA, it would be helpful if this decision were appealed, so that the Federal Court could clarify the law. (A Federal Court decision would bind the Tribunal.)

Reforms add to barriers:

This decision is based on the law as it stood before the reforms of October 2024. Since then, applicants also need to show they are likely to require NDIS Supports (as defined in section 10 of the NDIS Act, and transitional rules) under the scheme for the person’s lifetime.

Read the decision:

Burrows and CEO, National Disability Insurance Agency (NDIS) [2025] ARTA 607

Note:

* Rule 5.8 says: An impairment results in substantially reduced functional capacity of a person to undertake one or more of the relevant activities – communication, social interaction, learning, mobility, self-care, self-management…- if its result is that:

(a) the person is unable to participate effectively or completely in the activity, or to perform tasks or actions required to undertake or participate effectively or completely in the activity, without assistive technology, equipment (other than commonly used items such as glasses) or home modifications; or

(b) the person usually requires assistance (including physical assistance, guidance, supervision or prompting) from other people to participate in the activity or to perform tasks or actions required to undertake or participate in the activity; or

(c) the person is unable to participate in the activity or to perform tasks or actions required to undertake or participate in the activity, even with assistive technology, equipment, home modifications or assistance from another person. 

(Emphasis added.)

For the purposes of this Rule, the Tribunal held that adaptive techniques to record and remember information (e.g. notes and diaries) do not amount to “assistive technology” or “equipment” because “these are memory aides that might be used by anyone who does not have [an impairment].”  

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