Schedule 1 – Access and Planning Measures
Part 1 – Defining functional capacity
- Part 1 establishes the legal framework for determining access to the NDIS based on substantially reduced functional capacity.
- It also provides a definition of functional capacity.
- This enables future access decisions to be based on a consistent, objective and evidence-based assessment of functional capacity.
- The threshold and assessment process will be informed by advice from a Technical Advisory Group and engagement with the community and states and territories.
Part 2 – Limit unscheduled plan reassessments
- Part 2 tightens the criteria for unscheduled plan reassessments.
- Only participants, their plan nominee or guardian will be able to request an unscheduled plan reassessment.
- Unscheduled reassessments will only be possible when:
- there have been significant and ongoing changes to a participant’s support needs arising from changes in their functional capacity
- there has been an unanticipated, significant and ongoing change in a participant’s living, education, work or informal support arrangements
Part 3 – Strengthen link between an impairment and need for support
- Part 3 clarifies that supports will only be funded where the need for a support arises directly from an impairment for which the participant met the criteria for accessing the NDIS.
Part 4 – Support determinations
- Part 4 enables the Commonwealth Minister to make determinations to reduce funding for groups of supports.
- This will enable a Ministerial determination to reset participant support budgets for social, civic and community participation and capacity building daily activities.
Part 5 – Plan renewal
- Part 5 introduces a legislated end date for all participant plans.
- When a participant reaches their plan reassessment date, this will become their end date and a renewed plan will be created immediately after.
- Unspent funds from the previous plan will not be carried over to the renewed plan.
Part 6 – Reasonable and necessary supports
- Part 6 clarifies factors that must be considered by the NDIA when determining what supports are reasonable and necessary to fund.
- The NDIA must consider Scheme sustainability and equity across NDIS participants, including participants with similar needs and circumstances.
Part 7 – Plan suspensions
- Part 7 allows the NDIA to suspend an individual’s plan when reasonable attempts to contact them have been made and a response or adequate response has not been provided.
- It also allows an individual’s status as a participant to be revoked if their plan has been suspended for at least 90 days when the NDIA has not been able to contact them.
Part 8 – Tightening meaning of permanence
- Part 8 clarifies the definition of permanence in the Act, specifying that access will only be granted when:
- all appropriate treatment to remedy or alleviate an impairment has been undertaken
- no other treatment is likely to materially improve the impact of the impairment
- the impairment is likely to be lifelong
- There will be an instrument to outline circumstances where a participant has accessed all appropriate treatment.
Part 9 – Eligibility based on access to other services
- Part 9 clarifies where an individual is not eligible for NDIS if they access other service systems.
- Applicants will need to disclose if they are eligible for or accessing supports from a workers’ compensation or motor vehicle accident scheme for relevant impairments.
Schedule 2 – Fraud measures
Part 1 – Registration of NDIS providers
- Part 1 amends the definition of an NDIS provider.
- This will enable expanded mandatory registration requirements for providers delivering support to participants who are most at risk of abuse and/or exploitation.
Part 2 – Civil penalties and regulatory powers
- Part 2 inserts new civil penalties into the Act that can be enforced by the NDIA.
- The NDIA will be able to issue penalties for failures to comply with certain requirements, including requirements to provide information.
- It also gives the NDIA access to monitoring and investigation powers by triggering relevant provisions of the Regulatory Powers (Standard Provisions) Act 2014.
- The NDIA must undertake a risk assessment process before exercising regulatory powers in relation to a participant.
Part 3 – Information gathering powers
- Part 3 strengthens the NDIA’s information gathering powers.
- The NDIA will have stronger powers to ensure information can be lawfully obtained and used for the full range of its statutory functions, including criminal investigations and prosecutions.
Part 4 – Retention of records
- Part 4 sets out requirements for retaining certain records.
- Providers and participants will be required to retain records relating to the payment and receipt of NDIS amounts.
- A failure by a provider to retain the required records will result in a civil penalty.
- Where an individual receives an NDIS payment but has not kept records, a debt will be owed to the NDIA.
Part 5 – Reducing claim times
- Part 5 reduces the timeframe for making a claim for supports under a participant’s plan.
- All claims for NDIS supports will need to be made within 90 days of service delivery.
Part 6 – Registered plan management providers
- Part 6 clarifies the definition and registration requirements for plan management providers.
- This will enable the Government to commission a panel of plan management providers.
Schedule 3 – Governance arrangements
Part 1 – Decision-making on pricing
- Part 1 makes the Commonwealth Minister the decision maker on NDIS pricing.
- The NDIA will retain responsibility for conducting independent analysis and stakeholder engagement through its Annual Pricing Review to inform pricing advice to the Minister.
Part 2 – Automation of administrative action
- Part 2 allows the NDIA to automate specific administrative actions, with appropriate oversight and safeguards.
- This will include processing claims and payments.
Schedule 4 – New framework planning
Schedule 4 makes amendments to support the rollout of new framework planning from 1 April 2027.
These amendments:
- enable budget method rules to identify the type of supports and level of need arising from a support needs assessment
- clarify the support needs assessment must identify support needs directly linked to impairments for which a participant meets access
- clarify who can carry out a support needs assessment
- enable rules to specify what information an assessor must and must not consider
- enable a notice to transition to new framework planning where a support needs assessment needs to be paused
- clarify that official NDIA documents can be incorporated in the rules and be updated from time to time
- broaden the scope of value for money assessments for quotes for assistive technology and home modifications