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

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The list of medical diagnoses that guarantees access to the National Disability Insurance Scheme would be scrapped within five years under a set of reforms that seeks to ease pressure on the $42 billion scheme so that it does not buckle under its own weight.

It means a diagnosis of autism alone would no longer be enough for children to access individual support packages, which has become one of the scheme’s greatest pressure points.

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

More than 2.5 million Australians with a disability – including children with mild autism and developmental concerns – would instead receive services under a new system called “foundational supports” that will be established under a fresh agreement between state and federal governments so that the NDIS is no longer Australians’ only source of disability support.

That new layer of services will include home and community care supports, 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.

The independent recommendations from scheme architect Bruce Bonyhady and former education department head Lisa Paul, published on Thursday, aim to improve people’s experiences of the NDIS while dampening its growth trajectory so that it does not blow out to $100 billion within a decade.

A significant part of that will be supporting children, who currently make up half of NDIS participants, outside the scheme by delivering help in schools and childcare centres – places the reviewers say are more appropriate than clinical settings.

But 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.”

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

“It should not be based on a medical diagnosis alone or just your primary diagnosis… A focus on functional impairment will enable multiple disabilities to be considered – which when taken together, result in significant functional impairment.”

They said definitions in the NDIS legislation should be reset to link eligibility to the outcomes of a functional assessment process that can measure the impact of impairment and compare it to others.

“Reasonable and necessary” supports – another vague term that has created confusion in the NDIS legislation – would also be redefined, with people’s budgets instead based on a structured needs assessment.

Prime Minister Anthony Albanese on Wednesday said enabling legislation would be introduced in the first half of next year, with phased in implementation.

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.

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.

“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.”

NDIS Minister Bill Shorten will address the recommendations at the National Press Club on Thursday.

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