Patients must exhaust treatment options before turning to NDIS: draft laws
Patients must exhaust treatment options before turning to NDIS: draft laws
This will include specialist treatment even if patients are struggling to access it because of cost or distance.
AusDoc Ciara Seccombe, 15 May 2026
Patients will be forced to try all other “appropriate treatment” for their condition before
becoming eligible for National Disability Insurance Scheme funding under draft laws.
This includes specialist care even if cost or distance are barriers, according to explanatory
notes on the bill, which Minister for Health and Ageing Mark Butler introduced to Parliament
on Thursday.
The bill highlights how the Federal Government plans to achieve its goal set in this week’s
federal budget: cutting $36 billion over four years from the National Disability Insurance
Scheme (NDIS).
“This bill clearly outlines that people must undertake all appropriate treatments before an
impairment can be considered permanent or lifelong for the purpose of accessing the NDIS,”
Mr Butler told MPs.
“The NDIS was never intended to replace health, rehabilitation and treatment services which
play a critical role in preventing lifelong disability.”
The bill will also give the minister powers to cut funding to sections of the NDIS to “directly
manage the financial sustainability of the scheme”.
According to the bill’s explanatory notes, conditions will not be considered permanent unless
patients can demonstrate that no other treatment “is likely to materially improve, reverse, or
alleviate the impact of the impairment or impairments”.
“In this context, materially means noticeably or significantly.”
Finances or remoteness will not be excuses for not trying other treatments.
For example, the notes say a child with moderate hearing loss from chronic ear infections will
need to seek investigations and treatments to demonstrate the condition is permanent, even if
long wait times for ENT treatment in their area delay their access to care.
Asked if government payments could help cover this care, Mr Butler merely said he had an
“open mind”.
The notes say decision-makers will be allowed to consider cultural or personal belief systems
when deciding whether all appropriate treatments have been tried.
And they stress that treatment to maintain functional capacity — described as the ability to
undertake activities without help from other people, assistive technology or modifications — in
a patient with a demonstrated permanent disability will not disqualify them from the NDIS.
The Senate referred the bill to a committee inquiry to report on 16 June. Mr Butler said he
wanted legislation passed before Parliament’s winter break.
The bill follows the minister’s declaration that “diagnosis alone” will no longer be the gateway
to NDIS funding.
On Thursday, he said the government would establish a technical advisory group and
undertake community consultation “to identify the appropriate threshold of functional capacity
for the NDIS context”.
The budget also committed $127 million over four years to support the identification of
children with neurodevelopmental delays for the new Thriving Kids support program, which
starts in October, including MBS funding for GP health assessments for three-year-olds.
The Department of Health, Disability and Ageing told AusDoc that $3.1 million would support
evolving its Comprehensive Health Assessment Program into a GP tool to assess children
from three to 12 years old with established or suspected neurodevelopmental delay,
“providing a structured approach to identifying needs, prioritising care and supporting referral
pathways”.
Aside from NDIS cuts, the budget also flagged $674 million in savings over four years by
reducing MBS and PBS rorts, linked to a $147 million investment in tougher Medicare
compliance.
Asked for details, the department told AusDoc PBS compliance activities would be ramped up
significantly.
The department would also focus on the Medicare claiming functions in commercial software,
better education for doctors and stronger “up-front” controls to block incorrect claims, a
spokesperson said.
They said the moves reflected the 2023 ‘Philip Review’ into Medicare compliance, which,
among other findings, said Medicare compliance was “disproportionately” focused on
identifying incorrect claims retrospectively.
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