Yesterday, Minister for Health, Disability and Ageing Mark Butler spoke before the National Press Club, announcing the Federal Government’s plans for significant reforms to the National Disability Insurance Scheme (NDIS) in the coming year.  

The Australian Physiotherapy Association (APA) welcomes the Federal Government’s commitment to reform and to delivering the high-quality, evidence-based support that Australians with significant disability need for sustainable long term support, however some significant areas of concern remain and more detail is needed to understand the full impact of these changes.

In his address, Minister Butler proposed ambitious reforms aimed at strengthening the integrity and sustainability of the Scheme. This includes measures to combat fraud and eliminate disreputable providers, slow rapid cost increases, clarify eligibility requirements and ensure providers are qualified and registered. The proposed changes also signal a shift away from a diagnosis-based approach to one more focused on functional capacity and participant outcomes.  

APA CEO Rob LoPresti said that, while significant questions remain, and more details on the proposed reforms are needed, it will be critical to ensure that physiotherapists remain at the forefront of the NDIS in providing vital support for participants.  

‘As nationally regulated, highly trained health professionals with deep expertise in assessing, diagnosing and improving functional capacity, physiotherapists are extremely well placed to deliver the effective, outcome-focused support for participants that these reforms hope to achieve,’ LoPresti said.  

The APA has consistently called for reform of the Scheme, particularly the need to better recognise the role of highly regulated health professions and to prioritise support for individuals with significant functional impairment, and we are hopeful the legislative package and coming reform realises these needs.  

Additionally, it is promising that the Minister for Disability will now hold responsibility for pricing decisions, ensuring greater accountability for pricing changes, especially given the APA’s persistent concerns regarding the NDIA’s methodology in recent years.    

While reforms that are intended to improve and make the Scheme sustainable is welcomed, the APA has a number of concerns regarding their implementation and the potential impact on participants, particularly in relation to continuity of care, eligibility processes and service accessibility. Adjustments to eligibility, funding or service access can be deeply disruptive, particularly for individuals who rely on consistent, trusted therapeutic relationships to support and improve their functional capacity. Careful implementation will be critical to minimise disruption and protect participant wellbeing.

The APA emphasises that clinical input, including physiotherapy, will be essential in the next phase of reform, particularly in relation to eligibility assessments. A functional capacity approach must be underpinned by appropriate clinical expertise to ensure fair and accurate outcomes for participants. We echo stakeholder concerns, including those raised by sector leaders, cautioning against a one-size-fits-all approach to eligibility. The proposed establishment of a Technical Advisory Group presents an important opportunity, and physiotherapy is well positioned to contribute as experts in functional capacity assessment to help guide this work.

While the tightening of eligibility may support Scheme sustainability, it is likely to have significant flow-on impacts, leaving many far more reliant on state-based services that have been progressively diminished since the Scheme launched. The APA calls for the opportunity to work collaboratively with the Federal and state and territory governments to help shape these supports and ensure no participant is left without appropriate care.

At the same time, further detail is required on key implementation elements, including differential pricing and provider registration. Physiotherapists are already subject to significant regulatory oversight through Ahpra, so the Federal Government must prove that any additional registration and potential pricing differentials based on registration status reflect real additional costs, improve participant safety and access and do not penalise participants who receive appropriate services from high-quality unregistered physiotherapy providers.

In addition, the APA seeks clarity on how capacity building supports will be impacted. As a core function of the NDIS, it is critical that therapy services such as physiotherapy are appropriately funded and supported to continue delivering high value care which improves participant independence and long-term functional outcomes while also reducing costs to the broader Australian health system.

Further to yesterday's announcements, the APA has also been informed that the NDIA Annual Pricing Review is still expected in the coming weeks. The APA has advocated strongly for the reversal of the prior year cut and multiyear freeze on pricing, highlighting flawed methodology in NDIA assumptions. We will follow this closely and report to members as soon as further information becomes available.

While the APA supports reforms to strengthen the sustainability and integrity of the NDIS, it is critical that access to essential physiotherapy services is not reduced, ensuring participants continue to receive the supports they need to maintain and improve their functional capacity. More detail is required to understand the full impacts of the proposed changes, and the APA looks forward to consulting with the Federal Government, NDIA, and AHPA throughout the reform process.