Catholic Health Australia has made a submission on the design of a future NDIS access process. CHA supports the objective of a fairer and more consistent approach to accessing the Scheme, and broadly supports moving away from diagnosis-based access lists, provided the replacement assessment captures the real-world impact of a person’s disability and is backed by the safeguards, workforce and service capacity needed to make it work.

Principles that need measurable implementation

CHA broadly supports the draft guiding principles as set out, and their emphasis on rights, participation, equitable assessment and transparency. Their effectiveness will depend on how they shape assessment methods, evidence requirements and individual decisions. A nationally consistent process can still produce inequitable outcomes if people cannot obtain the evidence required or if assessment methods fail to capture the impact of their disability.

The submission therefore calls for implementation standards and public reporting on outcomes, covering assessment delays, disparities between cohorts, decisions changed on review and whether referrals result in appropriate support. CHA supports retaining the seven principles, with clearer requirements for supported participation, recognition of the relationships and assistance that sustain a person’s functioning, and particular attention to people experiencing poverty, geographic isolation and barriers to care. The availability of unpaid care should not be assumed to establish that this care can continue indefinitely or that disability-related needs have diminished.

Continuity of support across service systems

CHA calls for an additional principle addressing continuity of support and shared responsibility across service systems. Where a person is directed to another system, the process should establish whether suitable support is available and who will resolve any gap. For existing participants, responsibility for interim assistance should be agreed before current support ends, so that gaps between Governments and services are not left for individuals and families to manage.

Replacing diagnosis-based access lists

Lists A and B helped the Agency process applications during the Scheme’s rollout, but they established different pathways for people who could have comparable levels of functional impairment, particularly where a condition was unlisted or several conditions contributed to a person’s disability. Obtaining the diagnosis needed to use a streamlined pathway could also depend on personal means, location and specialist availability.

A more consistent approach to functional assessment has the potential to address these inequities. Removing access lists should preserve the evidentiary value of diagnoses, including what they establish about prognosis and impairment, and allow for streamlined assessment where eligibility is clear. Assessment should distinguish functioning achieved through assistance from capacity without that support, and account for the interaction between impairment and environmental barriers. Assessment tools must be validated for the cohorts in which they will be used, including cultural validation for Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse communities, with validation findings and limitations published and clear pathways for supplementary evidence.

Proportionate assessment and collect once, use many times

CHA supports assessment requirements proportionate to what remains uncertain about eligibility. Where existing evidence clearly establishes that the access requirements are met, the Agency should reach a decision without requiring another comprehensive assessment. A ‘collect once, use many times’ approach would reuse existing clinical reports, assessments and service records across access, planning and review where they remain accurate, relevant and suitable, with further evidence requested only to resolve an identified gap.

The submission also supports publicly funded access assessments and additional evidence required by the Agency, a named contact for applicants, accessible guidance, a choice of telephone, face-to-face and digital assistance, and independent advocacy where needed. These arrangements would reduce reliance on personal means and families’ capacity to navigate administrative processes.

Careful limits on the use of AI

Appropriately governed AI could assist with organising records, identifying existing evidence and coordinating appointments and referrals. Any proposed use should demonstrate a reduction in burden and delays after accounting for verification and correction requirements, and undergo privacy, security and equity assessment. Evaluative judgements about eligibility, permanence and support needs must remain accountable to human decision-makers.

Consent arrangements require particular care. Where consent is relied upon it must be informed, voluntary and specific, with supported decision-making and clear arrangements for withdrawal. Providing evidence for an access application should not be treated as blanket consent to unrelated AI processing or model training, and declining an optional AI-enabled service should not disadvantage an applicant or restrict access to human assistance and review.

Fluctuating, episodic and degenerative conditions

An impairment may be permanent even where its severity fluctuates, and a period of relative stability does not by itself establish that disability-related support is no longer required. Access decisions should draw on evidence of functioning over time, including the frequency, duration and severity of episodes, their cumulative effects and the assistance required between episodes. Applicants should not have to wait for deterioration or experience a crisis to demonstrate an impairment already established by the available evidence.

Communication and participation requirements should be identified before assessment begins, including interpreters, Auslan, alternative communication, accessible information and a trusted supporter chosen by the person. Referral pathways must also be capable of responding when needs fluctuate or escalate, with a receiving service confirming that it has both the expertise and capacity to meet the person’s needs.

Treatment that is reasonably accessible

CHA supports consideration of appropriate treatment when determining whether an impairment is permanent, but the assessment must distinguish treatment likely to remedy or alleviate an impairment from ongoing care that manages symptoms, maintains function or prevents deterioration. Continuing treatment, periods of stability or the prospect of some improvement should not, by themselves, displace evidence of permanence.

Treatment requirements must also reflect what a person can reasonably access. Public funding alone does not establish that treatment is available within a reasonable timeframe or accessible given waiting lists, out-of-pocket costs, travel requirements and cultural appropriateness. An applicant should not fail the permanence requirement on the basis of treatment that is not reasonably available to them, because gaps in the health system would then become grounds for exclusion from the NDIS, with the consequences falling most heavily on people already experiencing disadvantage.

The six recommendations

1. Adopt the guiding principles with implementation standards and public reporting that assess access, equity, continuity of support and participation alongside financial sustainability.
2. Strengthen the principles to require supported participation, recognition of informal care and attention to disadvantage. Add an explicit commitment to continuity of support, with agreed responsibilities for resolving service gaps and funding interim assistance.
3. Replace diagnosis-based access lists with a transparent, validated functional assessment process that accounts for environmental context and variation, preserves relevant diagnostic evidence and provides streamlined pathways where eligibility is clear. Support implementation with a trained workforce, reasoned decisions and accessible review.
4. Adopt proportionate assessment requirements and a safeguarded ‘collect once, use many times’ approach, with expedited decisions where eligibility is clear, publicly funded additional evidence and coordinated referrals. Any AI use should demonstrate practical benefit and be subject to appropriate consent, privacy and oversight arrangements, with evaluative decisions remaining the responsibility of accountable human decision-makers.
5. Require access and referral processes to recognise that permanent impairment may fluctuate and that needs may change without sustained deterioration. Use suitable longitudinal evidence, culturally validated methods and individual participation adjustments without unnecessary reassessment, supported by timely escalation and continuity arrangements when needs increase.
6. Base permanence decisions on individual clinical and longitudinal evidence, distinguishing ongoing management from treatment likely to improve functional impact. Require further treatment to be clinically appropriate and reasonably accessible, including in cost, location, timeframe and cultural appropriateness, with clear Government responsibility for addressing barriers and arranging interim support.