The NDIS Bill has passed. What now for Allied Health providers

The Bill I wrote about in May is now law. It passed both Houses on 19 August, got Royal Assent on 20 August, and the first changes started on 27 August. Most of what I wrote in May still holds. The dates are now fixed, and a couple of measures were added late that weren’t in the Bill as introduced.

The reform calendar

The dates below come from the commencement table inside the Act itself, cross-checked against the Department’s implementation timeline. This is the whole reform calendar as it reaches Allied Health rather than only the Act. The Act carries other changes as well, including debt safeguards and whistleblower protections, and DSC have covered the main ones. Everything below comes from this Act unless the row is tagged with where else it comes from.

New framework planning

Every participant is moving to a new kind of plan. A needs assessment produces a budget they can spend more freely across categories, replacing a plan built line by line. The rollout was pushed from July 2026 to April 2027 and runs to the end of 2030. I wrote in March about what that does to the evidence behind a plan, in the NDIS FCA problem nobody wants to talk about.

Plan renewal, from 1 February 2027

The change with a firm date is plan renewal. Today most plans get extended administratively and unspent funds roll over. From February a plan that reaches its end date renews automatically for 12 months: same supports, indexation applied, one-off funding removed and no unspent money carried across. A participant carrying an unspent balance loses it, and because the renewal happens automatically with no decision made, there is nothing to appeal.

The funding cut and hours cap

From 1 October the Minister can cut funding by a set percentage for two groups of supports:

• assistance with social, economic and community participation
• improved daily living skills

Improved daily living is the category most therapy is paid from.

The Bill as introduced let the Minister pick any group at all. The House narrowed it to those two during the Bill’s passage, and added the ability to carve specific supports out of a cut.

How big it will be

The Act sets no percentage. The Department has published what the government plans to do with the power: cut social, civic and community participation budgets by 50 per cent, and capacity building daily activity budgets by 10 per cent. Until a rule is made those are stated intentions rather than settled numbers.

One qualifier from the Department is worth considering:

Changes will not necessarily result in a 50 or 10 per cent reduction in how much you spend as you may not be currently using all of your budget allocation.

Department of Health, Disability and Ageing, About the changes to the NDIS

The reduction applies to the budget allocation rather than to what a participant spends.

A cut applies from the start of a participant’s next plan rather than partway through the one they’re on, and the Department describes it rolling through plans over a 12 month period. Anecdotally I’m already hearing that a significant portion of participant budgets are coming back lower at reassessment and renewal. What’s changed is that it’s now in the Act.

The hours cap, from 1 February 2027

A separate power lets the Minister set a maximum amount of funding, a maximum intensity, or a maximum number of participants per worker. It hasn’t been used yet, and it may never be.

The Minister now sets price limits

Price limits used to be the NDIA’s call, worked out through the Annual Pricing Review. From 27 August they’re the Minister’s, made on the Agency’s advice. I went through what this year’s Annual Pricing Review changed for Allied Health rates in June.

Nothing has changed in what you can charge, because no price limit has been set under the new power. What’s changed is what a price limit may now do. It may vary by:

• the qualifications and experience of the person delivering the support
• whether the provider is registered
• how intensive the support is
• how remote the location is
• whether it’s delivered in person or online
• what kind of participant it is, including how their funding is managed

That list isn’t exhaustive. The Act gives those as examples, then adds any other matters or circumstances, so the grounds are open rather than fixed.

Differentiated pricing is now written into the legislation. Whether it gets implemented, and how, remains to be seen, and the likely place it gets worked through is the therapy pricing review inside the NDIA’s three year pricing work plan. My own view is that it’s a matter of when, not if.

Reassessments and evidence

Functional capacity now has a definition

Section 9B, which this Act inserts into the NDIS Act, says a person’s functional capacity is their ability to undertake an activity:

either without assistance from other people, assistive technology or modifications, or only with… assistance from assistive technology or modifications that are commonly used and that the person would ordinarily use to undertake the activity

National Disability Insurance Scheme Act 2013, section 9B(1)(a)

For a child, assistance from other people that suits their age counts too. The Senate added both qualifiers.

Therapy has to link to the impairment the person got access for

From 27 August a support has to arise directly from that impairment. If a participant came into the Scheme for one impairment and has other difficulties, therapy aimed at those is harder to fund unless the assessment or progress report supporting their plan connects it back to the impairment they were granted access for.

A person can have more than one eligible impairment, so it isn’t strictly primary versus secondary. What counts is whether the impairment your therapy addresses is one they met the access requirements for. This applies to every plan approved from 27 August, and to reviews of earlier decisions.

Who can ask for a reassessment has narrowed

It is now the participant, their plan nominee or, for a child, the person who acts for them. Providers and support coordinators can’t. There’s a test as well: a significant change in the support needs that come from the eligible impairment, driven by a real and lasting change in what the person can do, or in where they live, work or study, or in their informal support.

That test also catches requests already lodged. A request a participant submitted in June, with your report attached, is now judged against a test that didn’t exist when you wrote it.

The NDIA now gets 90 days to decide rather than 21. If it doesn’t decide in that time the request is treated as refused, and a refusal can be appealed.

Then the test for reasonable and necessary tightens, from 1 February 2027

Cheaper alternatives get considered first. The NDIA has to look at whether a comparable support is available at lower cost and, where there is one, whether it represents better value. For equipment, if the participant’s situation is likely to change soon, the NDIA has to assume leasing is the better option unless there’s evidence the other way.

Evidence gets ranked. Where the NDIA is weighing two or more kinds of evidence about whether a support will help, section 34(1E) sets the order of importance it has to consider them in. On page 33 of the Act, that order is:

1. Published, peer reviewed research that applies generally
2. Evidence the support is effective given this participant’s circumstances, including their age and impairment
3. Evidence of how the participant went with the support in their previous plan, in improving, maintaining or slowing a decline in their function or their capacity for social and economic participation
4. Anything else the NDIA considers appropriate

Underneath that sit two refusal grounds that cut in opposite directions. The NDIA can decide a support isn’t effective where there’s limited or no published research behind it, even where the evidence for that individual participant is strong. It can also decide a support isn’t effective where there’s limited or no evidence it works for this participant, even where the general research is strong.

This reaches further than report writing. It decides which therapies are fundable at all, so it’s a question about your service model as much as your paperwork: whether what you deliver has a published evidence base behind it, and whether you can show it working for the person in front of you. You need both.

One detail worth noticing. The third tier counts evidence a support improved a participant’s function, held it steady or slowed a decline. Holding steady and slowing decline are both named, which matters if you work with progressive conditions.

A new reason to say no. The NDIA has to be satisfied a support wouldn’t be more appropriately provided or funded by another scheme or an existing government service. Therapy that could plausibly run through Medicare, Aged Care or a state health service sits closer to the line than it did.

Getting paid: the 90 day window

From 1 December the window to claim drops from two years to 90 days from the day the support was provided. It reaches every funding type, and what changes is who has to move.

• Agency managed. You claim, and it’s your 90 days
• Plan managed. The plan manager claims, and their 90 days runs from the day you saw the participant rather than from the day your invoice arrives. A plan manager won’t pay an invoice they can no longer claim against
• Self managed. The participant pays you and claims

A late claim can still be accepted where the NDIA is satisfied there were exceptional circumstances justifying it and the claim came within a reasonable period. Treat that as a safety net and build the process around 90 days.

The Minister has said the NDIA has no visibility of the evidence behind 90 per cent of the claims made by plan managers or by providers directly, which is around 600,000 claims a day. Everything in this Act about records, claiming windows and audit powers points at closing that gap.

Records, and who can check them

From 27 August you have to keep records relating to a claim for seven years. Records and who owns them is an important part of governance.

The NDIA can now check them itself. The Commission is the regulator most providers think about, and from 27 August the NDIA has its own set of powers alongside it. It can now do all of these: investigate, enter and inspect, issue infringement notices and compliance notices, accept enforceable undertakings and appoint its own inspectors and investigators. The Act also added tailored offences for dishonest and misleading conduct in claiming.

Gifts and incentives

This was written against the worst end of the market. The Australian Criminal Intelligence Commission told a parliamentary inquiry into the integrity of the NDIS about collusive arrangements between providers and participants, nominees or family members, including cash and other inducements. It described conduct running along a spectrum from knowing collusion through to coercion. That is what the provision is aimed at. It is drafted broadly enough to reach people who would never see themselves in that description.

From 20 November, giving a gift or benefit that’s reasonably likely to persuade someone to engage you, stay with you, add a support, increase its hours or move their plan management to you becomes an offence and a civil penalty. It doesn’t matter whether the person receiving it is the participant, so a gift to a support coordinator, a plan manager, a GP or a parent is treated the same way.

Two things set the bar. The gift has to be reasonably likely to persuade. And the highest penalty applies only to a serious contravention, which the NDIS Act defines as either a significant departure from what could reasonably be expected of a provider, or conduct that is part of a systematic pattern.

On that basis, all at 2026-27 values:

• a serious contravention by a provider carries a civil penalty of up to $3.64 million
• any other case is $91,000
• the criminal offence carries up to two years imprisonment or a fine of $43,680

Two exceptions are already in the Act. A discount or fee reduction that’s part of a legitimate pricing practice is out, and so is a provider’s own merchandise, which the Act doesn’t define. Five things sit permanently outside any exception the rules might later create:

• alcohol
• illicit drugs
• tobacco and vaping products
• cash and cash-like products
• electronic devices

The rules that settle the edges haven’t been made, so where the line falls isn’t yet clear. Worth knowing what you give away and to whom, particularly anything attached to a referral coming in or a client signing up. This is general information rather than legal advice, and anything you’re unsure about is worth putting in front of someone who can advise on your specific arrangements.

What improved in passage

Worth saying, because most of what’s above reduces something. The Bill introduced in May is not the Act that passed. Three of the improvements are above already: the funding cut was confined, functional capacity assessment got more realistic and appeal rights were restored. Four more have not come up.

• The reassessment test was widened to cover changes that were foreseeable as well as unexpected
• A pathway was created for the highest needs. Participants who need continuous 24 hour care can ask for a plan variation where a funding cut applies to them, though the cohort that covers hasn’t been defined yet
• Existing participants were protected from the 2028 access changes, which apply only to people who apply, or become a participant, on or after 1 January 2028
• A review was built in. The Bill contained no review at all. The Act requires an independent one, and the viability of the provider market is named in what it has to consider. The catch is timing: it does not begin until after September 2029, so the evidence it works from is whatever providers write down between now and then

Three things land in October

• Revenue. The funding cut power switches on, so funding per participant can start falling from the beginning of each next plan (though anecdotally it is already happening)
• Wages. New health professional classifications under the Health Professionals and Support Services Award, and the first stage of the gender undervaluation increases, start on 1 October, and employees sitting at Health Professional Level 1 or Level 2 translate into the new structure
• Referrals. Thriving Kids starts, nationally, for children aged 8 and under with developmental delay or autism and low to moderate support needs. It is fully rolled out by 1 January 2028 and jurisdictions set their own local timing. It moves a significant portion of the paediatric cohort outside the Scheme. Thriving Kids and foundational supports sit outside the NDIS entirely and need no Commonwealth legislation

For a paediatric-weighted provider all three arrive at once. For the market as a whole that convergence matters more than any single measure in the Act, because three separate instruments move revenue, cost and demand in the same direction at once, and the providers least able to absorb it are the smallest and the most specialised. That is how a market consolidates.

I wrote about the compounding risk of several changes arriving together back in March. October is the month it stops being a forecast.

What to do

1. Start with a progress note attached to every billable item, including non face to face time and report writing time. You can start tomorrow, and it answers three changes at once: the 90 day claiming window, the seven year record duty and the NDIA’s new power to come and look
2. Work on your invoicing cadence ahead of 1 December. Weekly at the least
3. Check what incentives or gifts you give away, and settle it before 20 November
4. Turn the funding cut into a number. Take the improved daily living funding across your participant list, apply 10 per cent, and see what it does to your year
5. Consider getting registered. Therapy is not in the mandatory categories, so it is a commercial decision rather than a compliance one: price may now vary by registration status, and commissioned work and subcontracting both ask for the governance an audit proves
6. Decide whether you’re doubling down in the NDIS or diversifying. There’s nothing wrong with doubling down on what you already do well, and if that’s the call, own it. The practices that cope best in a contracting market are the ones whose referrals come to them: known in their schools, known in their early childhood centres, part of the local community. That’s buildable

What comes next

Most of this has been signalled for a while, in the Department’s reform timeline, in the Budget and in what the Minister has been saying since his infamous National Press Club speech in April. What changed on 20 August is that the law to do it now exists.

The numbers arrive separately from the dates, and the pricing instrument has no date at all, which is worth remembering whenever someone tells you differentiated pricing is imminent.

None of which makes this a good year to be average. The market will contract and it will consolidate. The providers who come through that are the ones running a genuinely good service: quality that holds up when somebody looks, outcomes they can actually show, and the systems underneath to prove both. All of that was worth less when demand outstripped supply and anyone with capacity got referrals. It is worth considerably more now.

If you want to talk about what this means for your business, I’m happy to have a conversation.

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The Act is the National Disability Insurance Scheme Amendment (Securing the NDIS for Future Generations) Act 2026, No. 66 of 2026. The full text, every version of the Bill and all of the explanatory material are on the Parliament of Australia website.