S10 E5 - The NDIS Is Changing: Here’s What We Know

 The latest NDIS reforms bring another significant period of change for participants, families, OTs and providers. While legislation has progressed, many of the practical details still depend on rules, guidance and implementation processes that are yet to be developed.

For OTs, the priority is understanding what has changed, what is coming and what remains uncertain – without trying to predict decisions before the details are available.

New planning and support needs assessments

One of the biggest changes ahead is the introduction of new framework planning and support needs assessments. There is still uncertainty about exactly how these assessments will translate into participant budgets and how complex supports such as assistive technology and home modifications will be considered.

The role of professional evidence will also be important. Consultation feedback has highlighted the need for evidence from treating practitioners who understand a participant’s function and support needs over time. Testing of the iCAN tool is continuing, so there is still more to learn about how the assessment process will work in practice.

Functional capacity assessments are also coming

From 1 January 2028, access to the NDIS is expected to involve a standardised assessment of functional capacity. The reforms clarify that people can use common forms of assistance, such as glasses, hearing aids and walking sticks, during these assessments, while children can receive age-appropriate assistance.

The bigger question is how a standardised assessment will capture the complexity of everyday function. Occupational performance is influenced by environment, equipment, assistance and context, making the implementation of these assessments particularly important for OTs to watch.

Review rights could look different

The introduction of support needs assessments may also change what happens when a participant disagrees with their budget.

Rather than directly challenging the resulting level of funding, the review pathway described in the reforms may lead to another support needs assessment being completed. This raises questions about whether participants could find themselves repeating assessments when they believe their needs have not been adequately captured.

Changes to unscheduled reassessments

Participants will be able to request an unscheduled reassessment following a significant and ongoing change. Importantly, that change no longer needs to be ‘unanticipated’, which may better reflect the experiences of people living with complex or fluctuating disability.

However, the timeframe remains significant. If the NDIA does not decide on a reassessment request within 90 days, it is treated as refused, allowing the participant to move to a review rather than repeatedly submitting reassessment requests.

Greater clarity around parental responsibility

The reforms also clarify the distinction between ordinary parental responsibility and additional support required because of disability.

Parents are ordinarily expected to provide supervision, personal care, transport, emotional support and behaviour support. However, this does not include additional assistance a child requires because of their disability compared with a child of a similar age without disability.

For paediatric OTs, clearly describing this difference in functional evidence will remain important. The NDIS must also consider potential harm to informal supports, family relationships and informal networks if disability-related support is not funded.

Support determinations and critical supports

The reforms introduce mechanisms that could allow broader funding changes to particular categories of support. However, protections have been included for critical supports such as assistance with personal care and medication, mobility equipment, vehicle modifications, certain consumables and specialist disability accommodation.

Additional safeguards are intended for participants requiring continuous 24-hour care, including a plan variation pathway where broader funding changes could place their health or safety at risk.

Compensation and NDIS eligibility

From 1 January 2028, new applicants may not be eligible for the NDIS where their impairment results from a motor vehicle accident or work-related injury and another system provides compensation or benefits. Existing participants are expected to retain their current arrangements.

There are still significant questions about what happens when another compensation system only covers some disability-related needs. Further rules are expected to clarify these situations, so OTs should be cautious about predicting how the provisions will apply to individual participants.

The reforms also allow compensation to be considered when determining funding under new framework plans. Depending on the circumstances, an NDIS budget may be reduced to account for compensation a participant has received.

‘Appropriate treatment’ does not mean every treatment

The reforms provide some useful clarification about the requirement to consider ‘appropriate treatment’ when determining whether an impairment is permanent.

Participants are not expected to try every conceivable treatment. Treatment needs to be widely accepted and expected to significantly improve, reduce or manage the impact of the impairment. People are also not expected to undergo treatment that is unsuitable, carries significant risks or could cause major lifelong consequences.

For OTs providing evidence, the focus should remain on the likely impact of appropriate and accepted treatment rather than whether every possible intervention has been attempted.

NDIS support lists remain difficult to navigate

Consultation feedback confirms what many participants and providers have experienced since the NDIS support lists were introduced. Only 15% of respondents said it was easy to understand what could be funded, while 68% found it difficult. Around 77% had experienced or heard about situations where the rules were interpreted differently.

Feedback called for clearer ‘in’ and ‘out’ lists, greater flexibility around mainstream products and a simpler replacement supports process. These findings will help inform future changes, but there is still no clear picture of what the final arrangements will look like.

What OTs can focus on now

There are still many questions that cannot be answered. Participants may understandably want certainty about future plans and funding, but legislation is only part of the picture. Supporting rules and operational processes will determine how many of these reforms actually work in practice.

For now, OTs can focus on strong functional documentation, clearly distinguishing disability-related needs and following reliable updates as implementation progresses. Being able to say ‘we don’t know yet’ is also important when the information simply is not available.

Looking after yourself through ongoing change

Working within constant uncertainty can take a toll. OTs may understand what someone needs while having limited control over whether those supports are ultimately funded, creating frustration, moral distress and burnout.

Proactive wellbeing matters during periods of sustained change. For clinicians, business owners and teams, this might mean strengthening boundaries, creating space to discuss uncertainty and recognising that different people restore their energy in different ways.

The goal is not to personally carry every change occurring within the NDIS. Staying informed matters, but so does maintaining the capacity to continue doing good work as the system evolves.

Key takeaways for OTs
• New planning, support needs assessments and functional capacity assessments will significantly change how NDIS access and budgets are determined.
• The role of professional evidence remains important, but details about how it will interact with new assessments are still emerging.
• Unscheduled reassessments no longer require a change to be unanticipated, although significant timeframes remain.
• Paediatric OTs should clearly distinguish disability-related needs from age-expected parental responsibility.
• Compensation, support determinations and review rights are important areas to watch as further rules are developed.
• Consultation feedback confirms significant confusion remains around NDIS support lists and replacement supports.
• Avoid predicting individual outcomes while implementation details remain unresolved.
• Strong functional evidence, reliable information and proactive wellbeing will be important as the reforms roll out.

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