NDIS participants

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

David Kinnane · 12 June 2025 · Leave a Comment

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).

2024-2025 Annual Pricing Review

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

David Kinnane · 5 June 2025 · Leave a Comment

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].”

Small allied health NDIS providers: should we all be registered?

David Kinnane · 3 April 2025 · Leave a Comment

It depends on what you mean by “registration”.

The debate:

Large disability providers continue to lobby for universal mandatory provider registration, arguing it will enhance participant safety and the quality of supports, create an even playing field, and increase regulator oversight of the 90%+ of providers who are currently unregistered.

Leading disability advocates and some smaller providers argue universal provider registration would be a huge mistake because it would reduce participant choice and control, drive out small providers (reducing access), decrease competition for large providers, reduce incentives for innovation, and do nothing of itself to increase service quality or participant safety.

So who’s right when it comes to small allied health NDIS providers? And is there a middle path?

Context:

Under current rules, registration isn’t required for most of the work allied health providers perform to support self-managed and plan-managed NDIS participants (who make up over 90% of all participants). Among other things, unregistered allied health providers can’t support NDIA-managed participants or use regulated restrictive practices.

Why not register?

Getting and staying registered is too expensive and time-consuming for many small allied health providers – especially for providers who also work with other clients outside the disability sector (e.g. in health or education).

Many NDIS registration obligations duplicate existing professional and health regulations, requiring registered allied health providers to develop systems to comply with two sets of overlapping rules.

Unregistered ≠ unregulated:

Most evidence-based allied health professionals in Australia are regulated either by AHPRA, or by self-regulatory bodies and state statutory codes of conduct that impose similar requirements, including rules about professional ethics, standards of practice, scope of practice, mandatory declarations, complaints, certification, continuous professional development, and professional indemnity insurance. All providers – including unregistered providers – must abide by the NDIS Code of Conduct.

Deemed registration proposal:

In August 2024, the government released the advice of the NDIS Provider and Worker Registration Taskforce. The task force acknowledged the arguments of disability advocates and proposed that, to avoid duplicate accreditation and registration requirements:

AHPRA-registered allied health professionals have their existing registration recognised for NDIS registration purposes; and
consideration be given to the appropriateness of extending this recognition to allied health professionals who are self-regulated by rules that mirror AHPRA’s requirements (e.g. speech pathologists).

Avoiding false binaries:

Everyone wants participants to be safe and to receive high quality supports. But, as recent history makes clear, NDIS registration does not guarantee safety or quality.

Regardless of registration status, providers can – and should – look for practical ways to work with participants to improve the quality and safety of their services, including with robust worker screening processes and complaints and incidents management systems.

Bottom line:

Mandatory registration of allied health providers under existing rules would be likely to reduce participant choice and control because it would drive many small allied health providers out of the sector.
Recognising allied health providers’ existing health registrations/self-regulations as NDIS registration appears to be a sensible, risk-weighted approach. But we don’t yet know whether the government – now, or after the election – agrees or will agree with the task force’s recommendations.
Whatever happens, allied health NDIS providers must, in partnership with the NDIS participants they serve, continue to:
- assert their value in increasing participant choice and control; and
- work to improve the quality and safety of their supports.

Get ready:

NDIS Incident Management and Reportable Incidents System Policy and Procedures

NDIS Complaints Management and Resolution System Policy Document and Complaint and Feedback Form

Go deeper:

NDIS participants want safety and quality…but they also want choice. Article by Dr George Taleporos in The Australian (paywalled). 27 March 2025.

NDIS Provider and Worker Registration Taskforce Advice

Allied Health NDIS Providers: Keep your eye on the ball in 2025!

Election-mode engaged: allied health NDIS providers must keep an eye on federal health, education and disability policy priorities to support people with disability – and to anticipate service-delivery changes

Allied health NDIS providers must face facts, and make painful – but necessary – changes to survive

Paediatric allied health providers: government-funded, dedicated, multi-disciplinary needs assessors to provide “free” assessments for children under 9

David Kinnane · 18 December 2024 · Leave a Comment

What’s happened:

As part of the NDIA’s early designs for a new early intervention pathway for children under 9, the Government plans to create and fund a “dedicated, multidisciplinary workforce” of needs assessors to assess children under 9 with developmental delay or disability. Families will not need to pay for these assessments.

Driving the change:

The authors of the 2023 NDIS Review recommended the NDIA should reform the early intervention pathway for children under the age of 9 to enter the NDIS; and introduce a more “consistent and robust approach to assessing developmental delay”.
The Government claims that creating a new workforce of dedicated needs assessors will mean that allied health professional time will be “freed up” so we can spend more time delivering supports, “putting downward pressure on waiting times…over the next 5 years”.

Anti-provider undercurrents? While acknowledging allied health professionals have a “crucial role in the Scheme”, the Minister, in his press release (linked below):

states repeatedly that the aim of the change is to put participants “back in the centre of the scheme”, suggesting they’re not there now; and
unhelpfully claims allied health professionals write “expensive 80-page reports which are not able to be implemented”. (!)

Reality checks:

Nothing is changing right now for participants or allied health providers. The NDIA will need time to:
- create and (presumably) train a new dedicated workforce of needs assessors;
- consult with participants and professionals to identify valid and reliable assessment tools they can use to determine the NDIS support needs of children; and
- co-design and implement the rest of the early intervention pathway.
If the announced changes are implemented, families will have less choice and control over who assesses their child.
The proposal is a sustainability measure. There is no such thing as a free assessment – somebody will pay, e.g.:
- some families, through Government savings from decisions to revoke or not grant access to the NDIS, or through significantly reduced plan funding; and
- taxpayers.

What to watch:

What criteria (experience, qualifications, checks) will be required for someone to become a needs assessor?
How will needs assessors balance their NDIA policy objectives with their legal, ethical, and professional obligations to clients, their professions, and to the public?
Who will train and supervise needs assessors? To whom will they be accountable?
Which assessment battery/tools will needs assessors use to assess participants, and are they valid and reliable for the children assessed?
How will the (as yet undesigned) new early intervention pathway interact with the (as yet unfunded and unannounced) Targeted Foundational Supports system, and various mainstream supports systems in different settings and states to support children?

Assessment quality affects the safety and quality of NDIS supports:

To deliver safe, evidence-based, and quality NDIS supports to young children, allied health professionals need accurate, complete, and reliable assessment data, communicated in clear, trustworthy reports written by qualified professionals.
Reports shouldn’t be 80-pages long. But, to meet NDIS objectives and measure outcomes, they must take into account:
- a child’s delay or disability;
- the effects of the child’s delay or disability on their real-world functioning, inclusion, participation, and quality of life; and
- the family’s priorities and concerns.
Without solid assessment data and reports, allied health professionals will struggle to provide personalised, evidence-based and family-centred care, and to measure outcomes without spending scarce therapy time establishing baselines and evidence-informed therapy goals.

Bottom line

Allied health professionals should:
- continue to advocate for the choice and control of participants and families;
- push back against unhelpful anti-provider rhetoric that seeks to pit participants against providers in a zero-sum-game; and
- be proud of the work we do to deliver high quality, safe supports to children across the country, despite all the uncertainties and risks created by rolling reforms.

Minister for the NDIS Media Release: Putting participants back at the centre of the NDIS

Targeted Foundational Supports consultations: an “idea salad” with more questions than answers for allied health providers?

David Kinnane · 3 December 2024 · Leave a Comment

Last week, we attended two, lengthy webinars hosted by the team at The Social Deck, on behalf of the Department of Social Services, about Foundational Supports, including Targeted Foundational Supports. Our key takeaways for allied health providers of paediatric services are as follows*:

State of play:

Consultation period ends on 5 December 2024. Soon!
Weirdly, negotiations between governments are happening completely separately from community stakeholder consultations.
No update on the status of negotiations between the states and the Federal government, who will share the costs, 50:50.

General impressions:

Lots of stressed attendees. (Lifeline number shared!)
Frequent reminders from convenors that “we won’t be able to answer some of the specific questions about how foundational supports might work in the future” because they depend on what governments may decide to do.
Lots of very good ideas, but not clear how they could all work together in the real world. (One participant described the session as an “idea salad”, which I borrowed for the title.)
Private practitioners appeared to be under-represented in discussions, perhaps because the webinars occurred:
- in the middle of working days; and
- so close to the calendar year-end.

General themes:

Targeted Foundational Supports should:

include early recognition and assessment of needs;
be family-centred and holistic;
be consistent and continuous;
include disability-led organisations; and
include robust quality, safety and accountability controls.

Attendee concerns, including about:

NDIS changes and children falling through the “cracks” right now;
allied health workforce readiness, including training pathways and supervision;
gaps between evidence-based practices and front line realities;
how to ensure consistency and continuity of services;
how best to engage families and deliver family-centred care; and
how supports will work in rural and remote areas and for CALD populations.

Services delivery preferences:

General – but not unanimous – preferences for:

a move away from one-to-one, clinic-based therapy;
transdisciplinary and multidisciplinary teams;
service delivery in naturalistic settings using existing (public) infrastructure;
systems that promote longer-term relationships between families and professionals;
a movement away from medical models of care; and
key workers and allied health assistants having significant roles in the new system.

Many big questions remain:

Who will be eligible to deliver targeted supports and how will they be registered/certified?
Who will employ, train, and supervise them?
How (if at all) will allied health professionals access some settings, e.g. in states like NSW without a long history of integrated health/education service delivery?
Who will oversee and audit services, including outcomes?
How will services be funded? (Fee for service, block funding, fees for outcomes?)
What intensity of support is envisaged? (The consultation paper appears to envisage low intensity supports.)
Will recipients have any choice and control?
How (if at all) will upcoming elections affect the proposals, including their timing?