FREQUENTLY ASKED QUESTIONS

How did OTA engage with the Review?

The review was launched in October 2022 and was led by Co-Chairs Professor Bruce Bonyhady AM and Ms. Lisa Paul AO PSM.

The Review Panel given a wide-ranging terms of reference to inquire into the NDIS in two parts: 

• Part 1 of the NDIS Review, led by Dr. Bruce Bonyhady AM, examined the design, operation and sustainability of the scheme. 
• Part 2 of the NDIS Review, led by Ms. Lisa Paul AO, analysed ways to build a more responsive, supportive, and sustainable market and workforce 

The Review Panel delivered their final report to government in October 2023, and it was publicly released on 7 December 2023. 

Read the Final report here.

OTA made 5 submissions to the Review, and also met with the Review Panel on several occasions during 2023. We were very pleased to see strong engagement with our issues, and OTA’s views were quoted more than a dozen times in the Review’s Final Report and Supporting Analysis. 

What are the next steps for OTA?

The full Government response to the Review will be released in 2024, which we expect will see Federal and State governments decide what recommendations to adopt and when, and give us more detail on what will be changing.  

There has already been agreement at the December 2023 National Cabinet Meeting which saw Federal, State and Territory governments agree to: 

• Implement legislative changes to the NDIS to improve the experience of participants and restore the original intent of the Scheme to support people with permanent and significant disability, within a broader ecosystem of supports.  
• Adjust Federal and State funding approaches. 
• Design additional Foundational Supports to be jointly commissioned by the Commonwealth and the states.  

We expect that there will be a significant period of time when governments will work with stakeholders to design approaches and solutions to implement the changes, with strong indications this will be a co-design approach, alongside people with disability. The NDIS Review team has said they expect that it may take up to 5 years to implement the recommended changes.  

At OTA we know that we will have a busy few years ahead of us, as we engage with this next stage and represent members’ interests to ensure that the OT voice is heard.  Our objective is to make sure we understand the issues of most concern to our members and have a seat at the table to advocate on those issues to decision makers. 

OTA will be working with members, our National Reference Groups, and our partners like AHPA and MHA. We will also be utilising direct means like approaching key decisions makers, and continuing our role on advisory groups, like the NDIS commission Provider Advocacy Group.  We’ll be using all of these means to influence the way these are implemented to ensure the OT voice is heard and understood.  

What is in the report at a glance?

The report includes 26 recommendations and 139 supporting actions. 

The recommendations propose broad systemic change for the NDIS and the broader disability ecosystem, that will change how the NDIA operates, and introduce new supports and services outside the NDIS to try and make it easier to access supports regardless of someone’s status as an NDIS participant. There are also changes to regulation of providers, NDIS pricing, and many others.  

We think the Report approach and recommendations are a validation of OTs and the OT approach in disability. We have seen the Review recognise the need to move away from medical diagnosis and an access list, and recognising that the key to getting supports right is utilising skilled allied health professionals to assess support needs, through a new Needs Assessment Approach (more on this below).  

We have discussed the major changes affecting OTs in detail below. 

You can also read the NDIS Review’s “Review at a glance” easy read document here for more information. 

It is important to note that this is the beginning of a long journey and more information is needed about how governments propose to respond, and the detail of how these recommendations may be implemented at the coal face. That means at this stage, there are a lot on unanswered questions and we won’t have clarity on many things for a while, but we will be seeking more detail in coming months, and will share this with members as it comes to light. 

At OTA, we believe the Review report has presented some clear opportunities and benefits that will improve the system from participants and their families, and increase the role of OTs. 

Pleasingly we have had early indications from government that they see that there will be opportunity and growth for OTs in a number of key areas including in foundational supports, and as lead practitioners in the new early childhood system. 

Will there be changes to NDIS pricing?

In short – there will be no change to the way OTs are currently paid and this will remain fee for service for the time being, however it could change in the future. OTA lobbied strongly to maintain the current approach, and for an increase to the therapy supports maximum price.

The Review has signalled that it sees a longer term move away from fee for service arrangements in some areas. The have recommended changes to pricing policy, with the development of a new NDIS pricing and payments framework which will “look at better ways to pay providers to promote the delivery of efficient and quality supports and continuity of supply.” This may see changes in the way prices are administered in the future, with a planned move to look at outcomes-based payment in the future to reward providers for achieving participant outcomes. The Review also signalled a move to an enrolment type payment for shared living supports. 

There will also be a move to more independent price setting, with transfer of responsibility of price setting from NDIA to the Independent Health and Aged Care Pricing Authority to “strengthen transparency, predictability and alignment”. 

OTA supported more independence in NDIS pricing decisions and has also called for more transparent and realistic decisions that reflect the true cost of doing business, and take into account rising inflation. We will monitor this change closely to ensure that OT NDIS rates are not just compared to the fees paid in other government schemes (which are well below the true service cost). 

What is changing in Provider Registration? (Recommendation 17)

The Review recommended mandatory registration for all NDIS providers, with the level of regulatory oversight determined by the risk and complexity of the different supports they provide.  

They have flagged that they may look to a tiered range of registration types: 

• Advanced registration for all high-risk supports (such as behaviour support and daily living supports in formal closed settings).  
• General registration for all medium-risk supports (such as high intensity supports that may require additional skills and training like complex bowel care).  
• Basic registration for all lower-risk supports (such as supports with limited 1:1 contact such as specialist transport).
• Enrolment of all providers of lowest risk supports (such supports covered under general consumer law protections like equipment and technology). 

On 14 December 2023, Minister Bill Shorten Announced a new taskforce that will focus on the issue of NDIS Registration to hear more from stakeholders. OTA is keen to engage with this process to influence the conversation to ensure they understand the current time cost and admin burdens of NDIS registration, and the existing protections offered by mandatory AHPRA registrations.  

We are pleased that early indications from our recent discussions with the Review Panel and the Minister show that they recognise the level of protection offered by AHPRA registration and they do not anticipate heavier regulation of the OT profession. 

Nevertheless, we will be strongly advocating to ensure there is a decrease in regulatory burden for OTs, if registration becomes mandatory, to ensure that there is no increase in time or cost, for no added safety benefit. 

Read the NDIS Review fact sheet here.

What is planned for foundational supports? (Recommendation 4)

The Review recommended that disability specific supports are made more accessible for people with disability and, where appropriate, their families and carers, whether they are in the NDIS or not.  

States and Federal governments will fund these 50:50 and they will be designed to interconnect with existing mainstream services like childcare and schools.

From what we already know, this could look like: 

• Targeted foundational supports: home and community supports, personal assistance, early supports for children, targeted supports for adolescents.
• General foundational supports: Assistance to navigate the support system, information and advice, peer support and advocacy for individuals, families and communities. 

The Review has stated they see people with an NDIS plan also accessing some of these supports, or participants moving between foundational support and an NDIA package, depending on their level of need and life stage. 

At OTA, we are keen to ensure that people who cannot get onto the NDIS can still access tailored and individualised supports that meet community and individual needs, delivered by highly skilled practitioners with a focus on capacity building. It is essential that no person who requires the benefits of occupational therapy should fall between the gaps as funding models shift and change. 

Changes to the way people access NDIS (including Needs Assessments) (Recommendation 3)

The Review team has recognised the issues participants have faced in accessing NDIS support in a fair and timely way, and have proposed big changes to NDIS processes to make it easier to establish scheme access and get a plan. 

This includes changes to the way that people establish eligibility, with removal of the access list pathway option, and NDIA paying for any specialist reports that will be required. 

We want to know more about how this payment process will occur, to ensure OTs are adequately compensated, are able to provide a fulsome report that meets the participants needs, and that the clinician is given clear direction from NDIS on what information is required to meet their decision-making needs.  

The Review also recommended the introduction of longer-term plans (more than 1 year) to reduce ‘plan-xiety’ for participants. 

Needs Assessment 

Once eligibility is established, the Review recommended a change to the way supports are determined, with a new Needs Assessment. This would be undertaken by a ‘skilled Needs Assessor’ who will undertake a comprehensive needs assessment which will assess support needs from information provided by the participant, their family, and any medical or clinical professionals, which will be used to create an initial budget. The new approach is meant to be more person centred, looking at the whole-of-person level and include meeting with the participant in their own home, over several hours, with the Needs Assessor being the one who communicates the budget to the participant. 

The Review has recommended “The assessment should be completed by a skilled and qualified Needs Assessor who is a trained allied health practitioner or social worker, or similar, with disability expertise. “  

OTA is seeking more clarity on how this new process will be managed, as the Review panel has indicated this may be conducted in house by NDIS staff, or via contract arrangements.  

We think this change is a positive step if it’s done right. We think that’s a more person-centred way to set plan budgets, and it’s really taking an OT style approach which is great. But we want to ensure that this is what’s adopted, there’s no watering down, and that OTs are recognised as a perfect workforce to do this work. 

Read the NDIS Review fact sheet here.

What is happening in early childhood intervention? (Recommendation 9)

The Review recognised that there is a high number of children accessing the scheme and there is not enough support for children in everyday settings, where they live, play and learn. It recommends a better ‘continuum’ of supports for children under 9, which includes better early identification of developmental delays, and the scale up of foundational supports to meet this need, including an early intervention pathway, and more supports for families, 

They also propose a move to a Lead Practitioner model which would see a dedicated key worker who would “work with families in the best interests of the child to identify and address needs, connect them to foundational and mainstream supports, and provide information, advice and coaching to support their child’s development”.  These will be funded from participants’ budgets “including for the delivery of NDIS supports within their scope of practice” which we understand means that they may be a coordinator and a practitioner at the same time if appropriate for the client.  We are encouraged to see the Review has suggested the LP is an allied health professional. 

We note the report says that they should be registered, and that “Specific service delivery requirements for the Lead Practitioner will be set by the NDIA through contractual arrangements.” Which suggests that this could be provided through block funded services.  

This will be a big change in the way services are delivered and OTA is concerned to ensure that there is no major disruption to OTs who have moved to private practice to deliver NDIS services over the past 10 years. 

Read more in this NDIS Review fact sheet here.

What is changing for people with Psychosocial disability? (Recommendation 7)

The Review recommended a new, dedicated approach for people with psychosocial disability that better meets their episodic needs and is focused on personal recovery. 

This includes a new specialist early intervention pathway into the NDIS for most new participants with psychosocial disability to support personal recovery as soon as possible. Participants could stay in this new pathway for up to three years, after which they may be able to access NDIS plan supports. 

The Review report says that they see early intervention services to be “more targeted and effective evidence-based supports, to re-build participants’ functional abilities and improve lifetime management of their psychosocial disabilities and wellbeing”. This reads like they are including capacity building interventions in this area which is pleasing. However OTA wants to see much more detail on what this will look like in practice, and ensure that mental health trained OTs can be part of this service area.  

Another big change is the recommendation to introduce dedicated psychosocial recovery navigators who have knowledge about psychosocial disability and can deliver trauma informed support to help people access their supports. 

It also recommended that access to mental health services should be improved and there should be a strengthened interface between mental health systems and the NDIS. 

They also recommend new practice standards for psychosocial service providers, and mandatory registration for this area, due to concerns about participant safety, and service quality.  

These changes will improve arrangements to guarantee safety and quality of services for participants with psychosocial disability, but we have concerns that any move to blend across NDIS and tier 2 services needs to ensure that quality and individualised supports are available, and that people can still have choice and control.  

Read the NDIS Review’s Psychosocial Fact sheet here.

What do we know about Legislation change?

The Review recommended legislative reforms that will amend the NDIS Act to return the scheme to its original intent and improve the experience of participants. This includes legislation to improve eligibility and access, as well as an early intervention pathway for children. The Review anticipates this may occur in the first half of 2024. We expect an exposure draft will be released so stakeholders can understand what is changing. OTA will be actively engaging with federal representatives in the lead up to this to ensure the changes do not adversely impact OTs or participants. 

What are the new NDIS Navigators? (Recommendation 4)

The Review recommended the introduction of NDIS Navigators, and Specialist Navigators, to help people find and access all services available to them across mainstream services, community supports, foundational supports and the NDIS. 

These are designed to replace the role of LACs and support coordinators over time. The Review has recognised the need for specialist training and wants to see specialist Navigators who are skilled in the following areas: 

• Home and Living Navigators who will help a participant identify and trial housing options 
• Psychosocial Navigators who will be trauma informed and help access psychosocial supports 
• Shared support facilitator who will work with participants who share housing and living supports 
• Lead Practitioners who support children and families (these will help coordinate supports but may also deliver supports). 

The Review has said “Specialist navigation should be provided locally by staff with lower caseloads than other Navigators and have relevant experience managing complex situations and risks and ideally are qualified in allied health, social work or related fields.”  

OTA has been vocal about the deficiencies in the knowledge and approach of NDIA planners and Support Coordinators and we hope that this change will see better training, and better outcomes for people using their plan funds for the supports they need. 

Read more about the new Navigators here.

What is changing in Home and Living supports? (Recommendation 8)

The Review recommended more consistency in housing and living support budgets to make it fairer for NDIS participants.  

It also recommended a more flexible approach including the ability for participants to trial new living arrangements at different life stages, and Home and Living Navigators to help participants navigate these supports. 

While the Review has recommended a recommended ratio of 1:3 for shared supports, it has also stated “Sharing supports does not mean people have to share a home if they don’t want to”. 

Read the NDIS Review fact sheet on this topic here.

What is changing in restrictive practice? (Recommendation 18)

The Review has recommended steps to reduce and eliminate restrictive practice, and we are pleased they have recognised OTA’s concerns in their Report about inadequate behaviour support funding and behaviour support plans. 

They have recommended stronger efforts across government to eliminate practices, including more corrective actions from the NDIS Commission. They also recommend changes to improve the quality of behaviour support plans, including looking at funding models that will better enable providers to develop and implement behaviour support plans in timely way, and with adequate funding for quality behaviour support, and including risk assessment and safeguard building processes. 

We were disappointed that despite calls from many stakeholders, including OTA and the Mental Health OT Community of Practice, to look at increased recognition of sensory modifications, there were no specific recommendations on the increased support for these strategies, which are known to assist with behaviour support. This is something OTA will continue to advocate for in the NDIS space. 

Will the NDIS now have preferred providers? (Recommendation 11)

The Review has recommended the introduction of preferred providers in the area of capital support provision, which we know will be of interest to OTs. 

They have stated that this should include home modifications, assistive technology and consumables. 

Specifically they have recommended “Preferred providers should be paid a fee-for-service payment negotiated by the National Disability Insurance Agency (NDIA), reflecting the one-off, irregular and more transactional nature of capital supports. The NDIA should consider opportunities to work with other government agencies to further increase buying power across government-funded programs. Preferred provider arrangements should also include, where relevant, published, user-friendly, and standardised service agreements covering maintenance and servicing, as well as loan arrangements for assistive technology required for short periods.” 

OTA is particularly interested in seeking more detail on this proposal and if it will include any upstream impacts for the OTs who are recommending this equipment. 

The Review has also recommended the progressive introduction of preferred providers for allied health supports “in small and medium rural towns or where participants face persistent supply gaps” (recommendation 13).  Their direction about geographical remoteness was directed at areas that are rated 4 – 5 in the Modified Monash Model, and that “provider panels should leverage good providers already operating in these areas and be retested at least every three years”, with a suggestion that this approach is piloted first, before being more widely implemented. 

OTA argued strongly against scheme wide preferred provider arrangements as we have concerns that this may see many smaller therapy providers potentially go under, and limit participant choice and control. However, access to therapy supports in many regional areas is challenging and we acknowledge there is a critical need to guarantee support access in these areas. OTA will be monitoring this change closely to ensure that this remains a limited approach, and we will continue to caution against any further steps to introduce this across the entire scheme as it risks seriously disrupting the NDIS market. 

What about interactions with the Aged Care system?

The Review recognised that there are issues in the way the NDIS operates for older people, and how it intersects with the aged care system. They have recommended legislative change to allow participants who have turned 65 to receive supports in both the NDIS and the aged care system concurrently and clarify when aged care supports are reasonable and necessary (Action 2.11). 

The Review also recommended a nationally consistent approach for the delivery of aids and equipment outside the NDIS (Action 1.10) to improve planning and coordination the way aids and equipment are funded supplied between the NDIS, health and aged care sectors and across jurisdictions. 

We know both these changes will have interest and potential impacts for OTs and we will be monitoring them closely.  

Where should I go if I want to know more?

OTA will be adding to this webpage as we learn more.  

The NDIS Review has also published a series of FAQs. 

If you have questions, or don’t see a topic covered here that you want to know more about, please contact OTA via info@otaus.com.au