Diagnosis list for NDIS to be scrapped under five-year reboot plan

More than 2.5 million Australians with disabilities – including children with mild autism – could be eligible for help under a new system called “foundational supports” that will be created under a fresh agreement between state and federal governments so that the NDIS is no longer Australians’ only source of disability support.

Details of what the new system will look like when it is introduced in schools and childcare centres, as well as other community settings, have not been designed, but a major review unveiled on Thursday estimates the new scheme could provide less intensive support to four times the number of Australians currently using the National Disability Insurance Scheme.

The list of medical diagnoses that guarantee access to the NDIS would be scrapped within five years under a set of reforms that seeks to transform disability services in Australia and ease pressure on the $42 billion scheme so that it does not buckle under its own weight.

Under the new system, help for children with disabilities will be available in schools and childcare centres.Credit: Getty Images

Disability groups welcomed the NDIS review from scheme architect Bruce Bonyhady and former Education Department head Lisa Paul, and said they would work with NDIS Minister Bill Shorten on its next steps, which will require extensive design.

“Our reforms are designed to ensure that every dollar of NDIS support gets to those for whom the scheme was created,” Shorten said.

The review, commissioned by Shorten last year, aims to improve people’s experiences of the scheme while dampening its growth so that it does not blow out to $100 billion within a decade.

It estimates about 2.5 million Australians under 65 could qualify for the new supports, more than half the 4.4 million Australians who live with a disability. Currently, 630,000 people are on the NDIS.

That new layer of services will include home and community care support; aids and equipment; early childhood support; psychosocial services and help for adolescents and young adults – services that the reviewers do not think need to be delivered through individual NDIS packages.

A new electronic payment system would help the government track who was getting paid for what – and more easily pick up fraud or overcharging – while providers would have to register under a new tiered regulatory system that is proportionate to types of services they deliver.

A new role of “navigator” would be created to help connect people to the right services in an attempt to improve accessibility. The NDIS would also cover the cost of people’s application assessments, so they would not have to pay out of pocket.

NDIS Minister Bill Shorten on Thursday.Credit: James Brickwood

But a significant change will be supporting children, who currently make up almost half of NDIS participants, outside the scheme by delivering stronger support in schools and childcare centres – places the reviewers say are more appropriate than clinical settings.

Plugging gaps in psychosocial services for people who have a disability because of mental illness will be another key area of focus.

In one of the major changes to eligibility, access criteria will also be tightened to make sure the scheme is used most by Australians with significant and permanent disabilities.

Thousands of NDIS participants – in particular, children with autism level two or above – currently receive automatic access to the scheme through its diagnosis list, and remain on it for years.

“These lists were introduced during transition to the full scheme to accelerate access for some people ... However, they have led to a focus on medical diagnosis rather than function and disability-related support needs,” the reviewers said.

“These lists can provide simple and transparent access to the scheme for some children. However, they also exacerbate inequity and delay support for children with similar levels of need who may not have a diagnosis on an access list, or lack the means to obtain a diagnosis if they don’t meet the age criteria for developmental delay.

“We recommend removing automatic access under the access lists.”

Jim Mullan, the chief executive of autism organisation Amaze, said it was an important change. “It’s a very useful piece of housekeeping and return to the original intent of the scheme,” he said.

The reviewers said access to the NDIS should be based on the impact disability had on a person’s day-to-day life.

People applying for the NDIS will instead complete a detailed functional assessment that measures the effect of impairment on their lives and compares it to others. Their budgets will then be determined by a separate assessment, which moves away from the ambiguity of “reasonable and necessary” supports that are currently embedded in the scheme.

Bonyhady and Paul said they wanted all Australians with disability to have better access to mainstream services as well as the new foundational supports within five years.

“Our recommendations will support more children in existing services, such as maternal and child health, integrated child and family centres, early childhood education and schools – reducing the need for families to access the NDIS and leading to better long-term outcomes for children,” the review said.

“Children with higher support needs would get additional, individualised support through the NDIS via an early intervention pathway.”

Participants would have two years before they were asked to meet any new access requirements, while children under seven should be able to stay on the scheme until they turn nine.

People with a Disability president Nicole Lee said the five-year timeline was ambitious but she was confident it could be extended if it was in people’s best interests.

She said foundational supports were a significant commitment. “They don’t just benefit people with a disability, they benefit people who sit outside the scheme [and] everyone in the community,” she said.

“There’s a lot of nuance that needs to be worked out, and it was really good to hear from Bill Shorten that the nuance of all these things will be [worked through] with the disability community.”

Sam Bennett, director of the Grattan Institute’s disability program, said he was concerned that the detail required to implement the review’s ideas wasn’t there.

“It’s a pretty high level set of conclusions and recommendations, and there’s going to be a mountain more design work to even get to the point of being able to progress to implementation,” he said.

Coalition NDIS spokesperson Michael Sukkar said there was little detail about how the scheme would come down to an 8 per cent growth target by 2026.

“The independent review has left many questions unanswered and stones unturned. The government will now have to outline which changes they support and how they plan to transform these recommendations into tangible action,” he said.

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