The Australian Government has always taken a firm stance on fraud and non-compliance in the National Disability Insurance Scheme (NDIS) – and with the multi-agency Fraud Fusion Taskforce (FFT) investigating billions of dollars of payments made to NDIS providers, the focus on integrity has never been sharper.
Formed in late 2022, the FFT is co-led by the National Disability Insurance Agency (NDIA) and Services Australia, and has a raft of other member agencies, including the Australian Federal Police and the Australian Taxation Office. The Taskforce works to prevent and disrupt fraud against government programs – like the NDIS – and includes intelligence sharing, prosecution and other regulatory actions.
With safeguarding of participants, their funding, and the Scheme at the centre of the NDIA’s remit, the Agency has become increasingly vigilant when it comes to the conduct of NDIS providers.
To ensure people with disability can continue to access the vital supports they need, the NDIA has in place a number of compliance tools and guardrails that not only protect participants but also maintain the integrity of the Scheme.
Enter the payment integrity audit, designed to change behaviour in the NDIS by scrutinising claims and making providers accountable for the invoices they submit.
One of many tools in the NDIA’s fraud and non-compliance toolkit, a payment integrity audit is – in essence – a request from the Agency for more information about a claim.
It’s important that NDIS funding isn’t misused and it’s a legal requirement that it’s spent in accordance with participant plans, so the NDIA is increasingly using payment integrity audits to:
The Agency audits claims submitted by both registered and non-registered providers for supports provided to self managed, plan managed and Agency managed participants. The vast majority of audits take place before a claim is paid, but occasionally the NDIA investigates post payment.
When an invoice is submitted to the NDIA, the Agency’s systems run automated checks that look at key data points in a claim. Based on the information identified through those checks, the NDIA may ask a provider, a plan manager or both to provide more information to substantiate the claim.
The NDIS Act provides the Agency with powers to obtain information, recover debts, and bring legal proceeding against providers for non-compliance. In addition to denying a claim before it’s paid, the NDIA can continue to review future claims.
Payment integrity audits are conducted by a dedicated team at the NDIA – not by planners or local area coordinators – and current areas of focus include claims related to Short Term Accommodation, Supported Independent Living, support coordination, and some allied health supports.
As part of a payment integrity audit, the Agency checks flagged invoices and asks providers to substantiate their claims by providing some or all of the information below:
There’s no doubt that audits can be time consuming for providers, so it’s best to act quickly.
It’s your responsibility to act within the Agency’s requirements.
If your client is plan managed by us and the NDIA lets us know it’s auditing one of your claims, we’ll contact you and our experts will act swiftly to provide the Agency with the information it needs to complete its audit.
If the NDIA needs information we don’t hold – like rosters and timesheets – Agency staff will get in touch with you directly.
Typically, you’ll receive a request for information email from the NDIA which includes an explanation of what’s being audited and a reference number. If you’re notified that one of your claims is being audited, gather all available evidence to support the claim and provide it to the Agency as swiftly as possible. If you need more time, you can ask the NDIA to extend its deadline.
Once it has all requested information in hand, the Agency will consider the matter and make a decision. If it’s satisfied, it'll add the claim to the next payment run and let us know when it will be paid – and we’ll communicate that to you. If it isn’t satisfied, the NDIA may reject your claim.
The timeframe of audits is up to the Agency, so if you're awaiting an outcome and want to know what’s going on with the process, it's best to contact the NDIA directly.
When it comes to compliance, the best line of defense is to have your paperwork in order so you can clearly and accurately substantiate every NDIS claim.
Keep vital records, registrations and qualifications up to date, make sure to have service agreements in place with your clients, and review your invoices before submitting them for payment so you know they include all required information. Compliant invoices should include:
Before providing supports, check that your client has the necessary funding – in the correct funding categories – and ask them to email us a copy of the service agreement they have with you so you and they can be sure the funding is there when it comes time to claim.
My Plan Manager’s market-leading technology supports us to conduct payment integrity checks, ensure correct use of client funds, and enforce the NDIS Pricing Arrangements and Price Limits.
Every claim we receive undergoes 30+ automated checks to ensure it’s compliant with NDIA requirements, and that’s a great start when it comes to audits!
Don’t be lax about record keeping, be accurate, and be sure to have your paperwork in order, because the NDIA may request documentation before or after payments are made if it needs more information to substantiate a claim. These requests can be made randomly, so vigilance is key.
The Agency says that re-submitting a claim that’s been held for review is non-compliant behaviour – and resubmitting it within 14 days of the initial claim being made may trigger an even deeper review.
We understand there are times when duplicate claims are submitted by mistake, and if we spot one, we’ll flag it with you and let you know why it can’t be paid.
The aim of the FFT is to disrupt bad practice and fraudulent providers and it’s reportedly received tens of thousands of tip-offs since it was formed.
If you suspect someone is doing the wrong thing with NDIS funds, you can report your concerns. Find out how by clicking here.
If you have any questions about payment integrity audits, our friendly team is here to assist. You can call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.
Like most service providers, you’ll have experienced delays with a payment or two in your time, and you’ll be well versed in the woes those delays can cause.
In the National Disability Insurance Scheme (NDIS), although most providers are in the business of supporting people to live better lives, getting paid keeps the lights on and services running, which makes swift processing of claims pretty important too!
But with the National Disability Insurance Agency (NDIA) focused on stamping out fraud and non-compliant behaviour, its staff take a closer look at claims these days, which means it can take anywhere from two to 10 working days for funds to be released and payments made.
To help your invoices make their way through the queue as quickly as possible, we looked over some of the most common mistakes made in the claims we see and pulled together five quick tips for compiling quality invoices.
It’s a requirement of the NDIA that Supported Independent Living (SIL) supports are claimed from SIL funding and not from general Core Supports.
SIL must be stated in a plan and funding must be used in the way it’s prescribed by the NDIA. Be sure your client has SIL stated in their plan and use the correct SIL codes when claiming.
Line items let the NDIA know which budget category should pay for the supports you provide.
The NDIS Pricing Arrangements and Price Limits document contains more than 800 line items for providers to claim from, and the document changes from time to time, so we often see claims with line item codes that no longer exist.
To help you get paid in the shortest time possible, be sure the line item code you’re claiming against is up to date and applicable to the supports you delivered.
We often see invoices using a date range with one total charge, and sometimes they’ll state a quantity of hours that’s more than the number of hours in a day, which usually happens if there are multiple workers providing support to a client at the same time.
Whenever you submit an invoice, be sure to break down each support and include information such as:
You also need to include a separate unit price and quantity for extra costs, like travel. This makes it clear when something is an additional cost and not a charge for supports that’s higher than the price stated in the NDIS Pricing Arrangements and Price Limits.
Be sure to check your client has the budgets and categories that are applicable to your services, and make sure they have sufficient funding to cover your fees.
For example, if a provider invoices for personal training when their client doesn’t have appropriate funding in the Improved Health and Wellbeing category in their NDIS plan, the NDIA will reject the claim.
It’s also good to put a service agreement in place to reduce the likelihood of a claim being rejected (you can send us a copy of the agreement once it’s signed).
We recommend you invoice regularly because, when you do, your cashflow is less likely to be impacted if there’s something in a claim that prevents payment.
The NDIA says claims for Agency-managed participants need to be submitted within 90 days from the end of a service booking – but invoicing for supports as they’re provided, regardless of how your client’s NDIS funding is managed, is good business practice and it helps to keep money coming in too!
Developed to support providers just like you, our invoice tracker helps you check the status of your invoices as they progress from submission to payment. Status information is usually available 24 hours after you submit a claim.
You’ll find the My Plan Manager invoice tracker here.
If you have any questions, our friendly team is here to assist. You can contact us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday, or email us at enquiries@myplanmanager.com.au.
Every day, people across Australia are waiting for funding decisions from the National Disability Insurance Agency (NDIA).
You know the drill – first you need to submit evidence of your disability and its impact, then you have to provide information about the supports you need, and after that… you just have to wait.
It might be your first encounter with the Agency, or maybe you’ve been a National Disability Insurance Scheme (NDIS) participant for a while, but when it comes to requesting funding, everyone’s the same – and everyone plays the waiting game.
That’s why, when those hard-fought dollars are finally approved and the funding lands in your plan, it’s vital you balance your budget, so you don’t run out of cash early.
But sometimes – despite the best-laid plans – unexpected expenses arise, and your budget takes a hit. We’ve got some tips to minimise the impact if it happens to you.
With every new NDIS plan, it’s important to manage your funding so you can stay within budget and pay for the supports that’ve been approved for you.
Talking to us at the start of your plan period is a great place to begin. We can have a conversation and help you set up budgets for all your expenses, so you know exactly how much you can spend – and on what – and be sure your funding lasts.
These days, NDIS plans contain more stated supports than they did in the past and they often prescribe exactly what you can spend on, and how much. But you may also have some funding categories that are flexible, and if you do, we can help you to choose the supports you want to purchase.
Having a service agreement in place with your providers is also a great idea, because it means we can set aside funding to be sure it’s there when it comes time to pay them.
You can use our client portal (available via web and app) to track your spending, submit your claims, and generate monthly reports – which means you have all the information you need at the click of a button. If you haven’t used our client portal yet, you can get started here.
If you’re spending faster than you want to and you’re worried about your funding, contact your support coordinator, early childhood partner or local area coordinator as soon as possible to ask for help. The earlier you get in touch, the more likely they are to be able to identify ways to turn the situation around.
Working with them, you should be able to identify the supports you really can’t do without, and areas where you can potentially cut down on spending so you can see out your current plan period. For example, they may be able to help you with:
If you need changes made to your NDIS plan before your reassessment date, you can ask your support coordinator or your NDIA contact to help you with next steps.
Overspending before the end of your funding period isn’t, by itself, considered valid grounds for a plan reassessment, but if your circumstances have changed significantly and your existing budget is no longer adequate, you can let the Agency know and complete a change of details or change of situation form. You can read more about how to address a change in your circumstances here.
If you’ve gone through the process with the NDIA and you don’t get the funding you hoped for (and you predict your funding will run out as a consequence), you can ask for an internal review of the Agency’s decision. An internal review involves someone at the NDIA who wasn’t involved in the original decision looking at it to check if it’s correct under the law.
Plan check-ins and reassessments provide the NDIA with the information the Agency needs to make funding decisions and develop new plans. It’s important to prepare for these discussions so you have the best shot at getting the funding you need in the future.
The NDIA will contact you before the end of your current plan to see how you’re going and if your circumstances have changed. If your situation is stable, the Agency will usually check in every 12 months – at least two months before the reassessment date in your plan.
We explain how to prepare for your plan check-in here, and the NDIA provides plenty of tips for plan reassessments on this page on its website.
If there’s a roadblock with your funding, remember to act quickly. The NDIS is complex, but there are people who can help, and the earlier problems are addressed, the better the outcome is likely to be.
Don’t forget, you can email us or pick up the phone to talk to our friendly team of NDIS experts. We can look at your funding and provide advice about what to do next.
To contact us, email enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am-5.30pm (SA time), Monday to Friday.
You’ve decided you want to join the National Disability Insurance Scheme (NDIS), you’ve checked the criteria, and you’re confident you tick every box.
With success in mind, you carefully complete an access request form, gather every piece of evidence you can think of, and send it all off to the National Disability Insurance Agency (NDIA).
But what happens if your hard work doesn’t pay off and the access decision doesn’t go your way? What do you do then?
We explore next steps and options below.
Before you do anything else, it’s vital you understand why the NDIA decided you weren’t eligible for the Scheme. That information will be in the letter the Agency sends you once it’s considered your application.
There’s strict criteria for joining the NDIS – including age, residence, disability and early intervention requirements – so take a look at the NDIA’s eligibility checklist to see if you can learn more.
If a review of the eligibility checklist doesn’t shed any light, it may be that the NDIA decided the supports you need are best provided by mainstream services or the community. If that’s the case, you can still get information and support from a Local Area Coordinator (LAC) or Early Childhood Partner (ECP), and they can help to connect you to the services you need as well.
Mainstream supports come from government funded services like health, housing, mental health and transport, and there are services available through the community too.
Click here to find out more about supports and services provided by government and the community sector for people with disability. You may also be interested in the Information, Linkages and Capacity Building program managed by the Department of Social Services. The program provides funding to organisations to deliver projects in the community that benefit all Australians with disability, their carers, and families.
If you have new evidence to support your eligibility for the NDIS, or if your situation changes significantly, you can submit a new access request to the NDIA – unless you’ve requested a review of the initial decision, in which case you’ll need to wait for the outcome of that review.
When reapplying, it’s important to know why your application was rejected (remember: check the letter the NDIA sent to you), and to gather more evidence to show how your disability affects your life.
Providing insufficient evidence is often the reason NDIS applications are rejected, so if you’re reapplying, be sure to contact your medical and allied health professionals – along with others in your support network – to help you gather what you need. Important evidence includes:
If the NDIA thinks the evidence you’ve provided isn’t sufficient, you’ll be asked to give more information. The Agency explains what it considers to be good evidence here.
To reapply for the NDIS, you can complete this access request form, or you can contact your local NDIS office or partner office, or speak to a LAC or ECP, to ask for the form to be emailed or posted to you. You can also phone the NDIS National Contact Centre on 1800 800 110 to ask for help.
Once you’ve completed your access request form, you can email it to enquiries@ndis.gov.au or print it and mail it to the NDIA. Make sure all your supporting evidence is included. The NDIS Participant Service Guarantee outlines how long it should take the NDIA to get back to you.
If the NDIA decides you’re not eligible for the Scheme and you don’t agree with the decision, you can contact the Agency and ask it to explain how the decision was made, and what your options are.
You have three months from the day you receive the NDIA’s decision in writing to request an internal review. An internal review means and NDIA representative who wasn’t involved in the original decision will check if the Agency decided correctly – based on the information it had at the time – and they’ll also review any new evidence you provide.
Sometimes LACs and ECPs can help you with the internal review request and process, or they may connect you with an advocate who can assist.
There are a few ways you can ask the NDIA to review a decision. You can:
You can also send a letter with supporting evidence to:
Chief Executive Officer
National Disability Insurance Agency
GPO Box 700
Canberra ACT 2601
You can’t ask for an internal review if you miss the three-month window or if the NDIA withdraws your application because you didn’t provide information it asked you for in time.
You’ll find more information about internal reviews of NDIS access decisions here.
If you disagree with the outcome of the NDIA’s internal review, you have 28 days to ask the Administrative Review Tribunal to review it. This is called an external review.
The Tribunal can review an NDIS access decision, but usually it can only do so once the NDIA has reviewed it via an internal review first. However, if the NDIA hasn’t completed its internal review within the required timeframe, the Tribunal may be able to review the decision without waiting for the Agency.
You can visit the Tribunal website or call 1800 228 333 to request an external review. If you want an advocate or legal support at the Tribunal, you may be eligible for assistance via the NDIS Appeals Program.
The NDIS is a complex system, and a rejected access request doesn’t always mean the end of your journey in the Scheme – it may just mean you need to take a different route to get to where you’re going.
Not every outcome is or will be a positive one, but the most important tool to have in your kit is knowledge about your options. And remember, help is available.
We hope this roadmap supports you to navigate your path forward.
Life as a National Disability Insurance Scheme (NDIS) participant can be a hectic juggle at the best of times – a highwire act that sees you balancing time to access much-needed supports alongside the seemingly endless hours of administration associated with paying those who provide them.
At My Plan Manager, we have a really handy piece of tech that takes some of the paperwork pain away and puts you in control of your dollars – and your days!
With a simple, passwordless log in, you (and all our clients) can use our client portal to:
We explain all the best features of our client portal in this article. If you’re new to the portal, it’s a great place to start.
We’re pretty proud of the tools we offer our clients, and we try not to play favourites when it comes to their features and benefits… but honestly, we’re pretty fond of the client portal’s expenditure reports!
You may have seen emails from us at the start of each month reminding you to log into the portal for a spending snapshot of the previous month, but we’ll let you in on a little secret – you don’t actually have to wait until we email you before you can see what you’ve spent.
Just sign in to our client portal at any time (yep – that’s 24/7!) and, once you’re in, BINGO! You can pull a report that shows exactly what you’ve spent in each budget category, and you can customise the timeframe of the report to suit your needs as well.
Spending reports are powerful conversation-starters for discussions with your informal supports, your support coordinator, providers, and the National Disability Insurance Agency – and if you spot something that doesn’t look right, you can get in touch and ask us to take a look as well.
Information covered by the reports includes:
When you have multiple providers, it can be difficult to know where you’ve spent funding and if the charges are correct. But when you utilise the reports in our client portal, everything you need is broken down into simple, bite-sized chunks of information.
Consider this scenario:
Your NDIS plan says you have $8000 allocated to ‘Consumables’.
You create a report that indicates you’ve spent $6000 in the category, and you’re only at the end of the third month of your plan period.
The report lets you know you’re spending too fast, and it looks like you’ll run out of funding early. That prompts you to take a deeper dive into the client portal to find out more.
With the information in hand, you get in touch with your support coordinator or your NDIA contact to discuss your options and plan your next steps (like revising your supports or asking for a review of your funding).
Easy, right? Click here to explore our client portal (if you don’t already use it), or if you’re already a convert and you know your way around the platform, just log in and select ‘Reports’ from the menu options.
Oh, and did we tell you that you can grant client portal access to your support coordinator (or someone else) if you want to? Just ask us and we’ll explain how.
If you have any questions about our client portal, you can email us at enquiries@myplanmanager.com.au or call us on 1800 861 272 from 8am–5.30pm (SA time), Monday to Friday.
There’s no doubt about it; we live in expensive times!
With the cost of living going up, and inflation and interest rates showing only early signs of coming down, we know every dollar counts in households across Australia.
That’s why it’s so important to recoup out-of-pocket expenses wherever possible, so you can keep your money where it belongs: in your wallet.
Cue the My Plan Manager crash course in National Disability Insurance Scheme (NDIS) reimbursements.
An NDIS reimbursement happens when you use your own money to pay for a support or service that’s been approved by the National Disability Insurance Agency (NDIA), and then you submit a claim to be paid back for it (as long as your NDIS plan has funding available for it).
Maybe you’ve purchased a non-slip bathmat or a portable ramp, or maybe you have a transport budget, but you’ve paid a taxi fare with the cash in your pocket. Or perhaps you’ve purchased a walking stick to help you to get around more independently. Whatever it is, if it’s been approved by the NDIA and you have the funding available in your plan, you can send a claim to us, and we’ll get the ball rolling.
There are a few tips and tricks for getting reimbursements right, so we recommend you keep reading.
Making a claim is easy – just follow two simple steps:
#1. Make sure you get a receipt or tax invoice
To ensure compliance with the NDIA – and to give us everything we need to process your claim and submit it to the Agency for review – you’ll need to provide a receipt or a tax invoice that shows you’ve paid in full. The Australian Business Number (ABN) of the business you paid needs to be included on the invoice too.
#2. Submit your claim
There are two simple ways to submit a claim for reimbursement, but the one we recommend (because it’s quicker and keeps you updated as your claim progresses) is to use our client portal.
Available via web and app, My Plan Manager’s client portal is easy to use, it offers stacks of features to help you take control of your funding, and it makes submitting claims a breeze. Best of all, once you put your claim into the portal, it files it straight away, so you can see the payment status whenever you want to.
Explore everything our client portal has to offer here – or if you already use it, then jump online, log in, and refresh your knowledge so you can submit and monitor the progress of your claims with ease.
If easy-to-use tech isn’t your thing, you can submit a reimbursement by email instead. Find out how to do that here.
Your NDIS plan includes information about the supports you can use and the funding that’s available for you to spend. Every person is different, and so are their plans, so make sure to check yours before you start spending.
If you’re a My Plan Manager client and you want to make sure your reimbursement requests aren’t rejected, we recommend you check with our NDIS experts first before making a purchase. Their advice will give you the confidence to use your funding correctly so you can access the supports you need.
You can also ask your NDIA contact for advice or visit the NDIS website for information about the types of supports you can buy with your NDIS funding.
Legislation has tightened up spending in the Scheme, and participants can only use their funding to purchase approved supports. There are also rules about what funding can’t be used for. You can find out more about what’s approved and what’s not by clicking here.
Once we receive a compliant claim (which means that everything we need to review and send to the NDIA is there), we check that it meets the Agency’s rules and requirements, and then we submit it. That usually takes less than 48 hours.
Like us, the NDIA is focused on protecting you and your funding, so Agency staff may need up to 10 working days to review a claim, but in many cases it’s a lot quicker than that.
Once that’s done – and assuming everything is correct, and the claim is approved – the NDIA releases the fund to us, and we pay the claim.
You can find out more about the process here.
Note: If you’re accessing ongoing supports, it’s best to have your provider invoice us directly. That way, you’re not out of pocket and we’ll be able to process the claim faster!
If you have questions or need a little support before you submit a claim, just give us a call on 1800 861 272. We’re on hand to assist from 8am-5.30pm (SA time), Monday to Friday.
Right now, there’s a lot of talk about National Disability Insurance Scheme (NDIS) eligibility reassessments impacting the lives of people with disability.
Although they’ve been around for years, eligibility reassessments have been the talk of the town since changes were made to the NDIS Act in late 2024, and they’re a regular fixture in debates and discussions about access, funding, supports, and all things NDIS.
So, what’s the go? Well, buckle in – because we’ve got you covered!
An eligibility reassessment helps staff of the National Disability Insurance Agency (NDIA) understand if your support needs are being met or if they’ve changed – and whether you still fit the eligibility criteria for the Scheme.
If it looks like you may no longer be eligible for the NDIS, you or your nominee will receive a letter from the NDIA, and you’ll be given the opportunity to provide information to inform the Agency’s decision-making process.
Here’s how eligibility reassessments work:
#1. You’ll receive a letter from the NDIA
If the NDIA decides to look at your eligibility, you’ll receive a letter to tell you which eligibility requirements the Agency is looking at, and you might also be asked to provide evidence– such as reports from your providers.
#2. You’ll have time to gather your documents
Not every eligibility reassessment requires input from the participant, but if there’s information or evidence you want to submit – or if the NDIA asks you for some – then you’ll have 90 days to gather everything you need, and you can request a bit more time if you need it.
Previously, the NDIA required all supporting information to be delivered within 28 days but following feedback from the disability sector and NDIS participants, that timeline was extended to 90 days in early 2025.
The NDIA staff who make the decision about your eligibility will be different from those who first decided you were eligible for the Scheme and separate to those who approved your NDIS plan (or plans). What that means is the decision will be made independently by people who don’t have a personal connection to you or a history of making decisions about your NDIS supports.
“While eligibility reassessments have always been a part of the NDIS, we know the experience is likely to be a new one for most participants,” says NDIA CEO, Rebecca Falkingham. “This means the process can make people feel stressed or unsure.”
“For some participants, their support needs won’t change. For others, they may reduce over time.”
If you’re not sure which requirements you met when you first joined the NDIS, take a look at the access decision letter that was sent to you at the time, or contact the NDIA to find out.
If you’ve had an eligibility reassessment in the past, you should’ve received an outcome letter as part of that process, and that should include details about why the Agency decided you should continue to receive NDIS supports.
#3. The NDIA makes its decision
The legislation says that once the NDIA has all the evidence it’s asked for, it has 14 days to make a decision or to request more information.
If the Agency reassesses your eligibility and decides you still meet the criteria for the Scheme, nothing changes. You can continue using your NDIS funding for the supports you need.
If your status as an NDIS participant is revoked, you can speak to the NDIA to find out more, or you or your nominee can request an internal review.
If you don’t agree with the outcome of the internal review, you can apply to the Administrative Review Tribunal for an external review.
Under new legislation, people appealing decisions about their NDIS eligibility can’t submit a new access request until the review has been completed.
To find out more about what to do if you don’t agree with a decision the NDIA makes, click here.
During a parliamentary hearing held in late 2024, the NDIA confirmed it was conducting some 1200 eligibility reassessments each week, with around 48 per cent of cases resulting in the person having their NDIS eligibility revoked. Eighty per cent of the reassessments related to early childhood participants, with the remaining 20 per cent covering participants of different ages and with a range of disability types.
The NDIA is particularly focused on the ongoing eligibility of people who receive support through the NDIS Early Intervention pathway (usually children). That’s because evidence shows that supporting people early can improve outcomes and reduce the need for supports later in life.
But not everyone who has their eligibility reassessed is a child. Sometimes, the Agency might reassess your eligibility for the Scheme because there are questions about whether you meet the residency or disability requirements of the NDIS. If that applies to you, the NDIA will guide you on the type of evidence it needs to help it make a decision.
Eligibility reassessments aren’t new, but recent changes to legislation mean the NDIA is playing close attention to the support needs of current participants, and considering the most appropriate sources of those supports (including mainstream and community services, as well as the NDIS).
If the Agency notifies you that it’s reviewing your eligibility, you’ll still be able to use your NDIS supports while an audit of the evidence the NDIA has on file is underway. If your plan is being reassessed at the same time as your eligibility, you might get a new plan, so your ongoing supports aren’t interrupted.
The Agency will try to get the information it needs without asking you to provide further evidence, but NDIA staff might also write to you to ask for specific information or a report in a format that helps them to make an eligibility decision.
Make sure you read any letters the NDIA sends to you, so you know exactly why your eligibility is being reviewed, and consider talking to family members, friends, trusted providers, or even a disability advocate to get help with providing information to support your case. You can talk to the NDIA too.
“No matter a participant’s circumstances, we want them to feel supported in every interaction they have with the NDIA,” says Ms Falkingham. “That’s why we are committed to always improving the ways we work.”
In early 2025, the new Minister for the NDIS, Amanda Rishworth, reportedly told The Australian newspaper that the Federal Government isn’t planning to change the NDIS eligibility criteria – which means the reasons why someone can or can’t stay in the Scheme aren’t expected to change.
You can find out more about the NDIS eligibility criteria here.
The National Disability Insurance Scheme (NDIS) is founded on the ideals of the free market, with people with disability being active consumers who’re able to make choices about where they spend their funding to receive the support that suits them best.
But choice and control doesn’t have the same impact when choice is limited.
And choice could become challenging, it seems, with 21 per cent of providers who responded to a national survey detailed in the National Disability Services (NDS) State of the Disability Sector Report, saying they’re considering getting out of the sector entirely.
Their considerations could be linked to the fact that half the provider respondents to the survey reported they made a financial loss in the 2023-2024 financial year, while just 13 per cent broke even. Additionally, 80 per cent of respondents said they were concerned they wouldn’t be able to continue providing NDIS services at the rates outlined in the current NDIS Pricing Arrangements and Price Limits (the Price Guide).
Why does this matter to participants? Well… because, if providers can’t cover their expenses – including staff training, compliance, recruitment, retention, filling vacancies or finding new clients – they’re at risk of shutting up shop, leaving participants with less choice or, even more critically, at risk of being unsupported.
And all of this is happening against the backdrop of the rising cost of living that’s impacting all Australians. Utility bills have gone up, insurance premiums have increased, petrol prices have surged, and yet many items in the Price Guide have remained the same for at least five years.
Weigh all that up and the maths is simple – it costs more today to do business.
NDS CEO, Michael Perusco, says the State of the Disability Sector Report shows it’s vital the National Disability Insurance Agency works with providers to achieve policy settings so providers can continue to serve and support people with disability and their loved ones.
"We are particularly concerned about the likely closure of some long-standing services across the country. This will leave people with disability with fewer options and some with very complex needs will have no other options at all,” says Mr Perusco.
"These organisations are acting as the safety net for people, particularly when there are no suitable alternative federal, state or non-government supports available.
"It is incredible to see the adaptability and resilience of many service providers in a tough environment as they continue to work hard to support to people with disability, but they too need support to keep going.”
So, what does the future hold?
The NDS survey found almost all providers (96 per cent) are working hard to improve productivity and 51 per cent want to expand their operations, but they can’t do that much longer under current conditions without government support.
“What’s needed is assistance with innovative measures to improve productivity, fair funding that supports sustainable services, and action to build a stronger workforce and provide more employment opportunities,” says Mr Perusco.
There is a will and a drive to work smarter and be creative to find solutions for participants. But no-one operates in a vacuum and NDS warns that the Federal Government – which controls much of the way the NDIS operates – must support effective operations for providers. Meanwhile, it says state and territory governments must ensure foundational supports are in place, in order to contribute to the sustainability of the NDIS.
The Scheme is Australia’s biggest social reform since Medicare. And that means we owe it to each other and the people with disability who are participants – or who will join as participants – to get it right, now and in the future.
By now you’ll know all about the National Disability Insurance Scheme’s (NDIS) new spending rules and how they’ve changed the way funding is allocated and used.
The National Disability Insurance Agency (NDIA) has defined the supports participants can’t and can’t purchase, and clarified the rules around requesting a substitute – known as a ‘replacement support’.
The question is, what exactly is a replacement support, what can it replace, and when?
The NDIA defines a replacement support as a service, an item, or equipment a participant would like to use instead of the NDIS support or supports in their plan, with the Agency confirming replacements are substitutes and not additional supports.
Currently, the list of replacement supports is limited to:
Replacing an approved support with a standard commercially available household item may be considered when there’s clear evidence that the need relates specifically to a participant’s impairment.
You can discover more about impairments and how they relate to NDIS eligibility here.
A replacement may also be considered if it’s seen to increase ‘whole task’ independence and reduce or remove the need for a support worker or disability specific assistive technology (e.g., a blender to prepare meals aligned to a modified diet).
The NDIA may consider a replacement when a participant needs a device or app to meet communication and accessibility needs arising from disability. An example could include a non-verbal participant utilising a tablet to communicate with their loved ones and service providers.
Any smart device used for tracking purposes could be considered a restrictive practice and needs to be considered in this context.
The NDIA needs to be satisfied that a replacement support will provide the same or better outcomes and cost the same or less than a support that’s already included in a participant’s plan. Participants must apply for – and receive – approval of a replacement support before purchasing the support. To do that, they can fill out an application for a replacement support, or provide the NDIA with information to support their request by email or via a phone call to the Agency. Only some supports can be replaced and only if the NDIA agrees in writing.
If an application for a replacement support isn’t approved, the participant must wait 12 months before they can request it again. The NDIA’s decisions about replacement supports aren’t reviewable, meaning participant can’t seek to have the decisions reversed.
To keep up to date with changes to the NDIS as they come up, be sure to bookmark and visit these pages:
Summary of legislation changes | NDIS
