OT Unplugged: Community of Practice Insights

With so many changes happening across the NDIS, it can be difficult to distinguish between official policy, individual planning decisions and information being shared second-hand. Reports of new funding restrictions and conflicting advice are creating confusion for OTs, participants and families. Knowing when to question information, where to find reliable guidance and how to challenge an NDIS decision is becoming increasingly relevant. There are also emerging concerns about what the next phase of the NDIS funding reset could mean for participants with approved but unspent assistive technology and home modification funding. When NDIS advice doesn't match the rules Recent reports from the OT community have included claims that the NDIS will only fund four hours of allied health services and that participants must attend clinic-based appointments rather than receive therapy in the community. These examples raise questions about whether individual planning decisions are being incorrectly presented as broader NDIS policy. With significant reforms underway, conflicting information can be particularly difficult to navigate. Before accepting advice as an established rule, OTs should seek clarification and refer to published NDIS legislation, operational guidelines and policies. Asking where a particular requirement is documented can help distinguish genuine policy changes from individual interpretations. Questioning decisions with curiosity Challenging incorrect information doesn't need to begin with confrontation. Approaching conversations with curiosity and asking respectful, specific questions can help clarify misunderstandings while maintaining productive working relationships. This is particularly relevant when communicating with NDIA staff, who are also navigating substantial legislative changes and the challenge of implementing new policies. Seeking clarification early can prevent unnecessary assessment work, delays and frustration. Where advice appears inconsistent with published guidance, requesting the source of that information provides a useful starting point. When administrative errors delay essential supports Complex home modification applications can involve lengthy delays, repeated requests for documentation and difficulties establishing what information the NDIA has received. One example involved a participant whose home modification application was delayed because the NDIA indicated that required quotations and supporting documents were missing, despite evidence that they had previously been submitted. Maintaining clear records of submissions, correspondence and supporting evidence can be valuable when challenging these situations. It also helps establish whether delays relate to outstanding information, administrative errors or decisions requiring formal review. Challenging NDIS decisions and escalating concerns When an NDIS funding decision appears incorrect, a Section 100 review of a reviewable decision provides an opportunity to challenge the outcome. Applications generally need to be made within 90 days of receiving the decision. A strong review request should go beyond stating disagreement. Understanding the reasons for the original decision and providing additional evidence that addresses those concerns can improve the opportunity for a different outcome. Where matters remain unresolved, other pathways may be available depending on the circumstances: • Administrative Review Tribunal (ART): For eligible decisions following an internal review• Commonwealth Ombudsman: For complaints about NDIA administration, including delays and handling of matters• Local federal MP: A potential avenue for assistance with prolonged delays or unresolved administrative concerns• Professional association advocacy: Industry advocacy opportunities for assistive technology and home modification issues, including those raised through professional associations These pathways serve different purposes, so identifying the outcome being sought is an important part of deciding how to proceed. The next phase of the NDIS funding reset From 1 February 2027, the next phase of the NDIS funding reset will extend to existing plans through the renewal process, including plans with future end dates that may be brought forward. A significant concern relates to one-off funding for assistive technology and home modifications. The explanatory material accompanying the changes indicates that unspent one-off funding may be removed when plans are renewed. This could create serious difficulties where funding has already been approved but equipment trials, product availability, quotations or construction arrangements have delayed expenditure. An example involving a participant who delayed purchasing a nearly $20,000 power assist device illustrates the potential consequences. The Australian Rehabilitation and Assistive Technology Association (ARATA) has raised concerns about this issue, with clarification needed before the next phase commences. Key takeaways • Verify reported NDIS funding restrictions against published legislation and operational guidance before accepting them as policy• Approach conflicting advice with curiosity and request clarification about where requirements are documented• Maintain clear documentation of submitted evidence, quotations and correspondence to support escalation when necessary• Use Section 100 reviews to challenge eligible funding decisions, supported by evidence addressing the original reasons for refusal• Consider the Commonwealth Ombudsman for complaints about NDIA administration and prolonged delays• Monitor the February 2027 funding reset and its potential implications for approved but unspent assistive technology and home modification funding

Keeping up with NDIS reforms is becoming increasingly challenging for OTs, particularly when changes to funding, planning and evidence requirements have significant implications for clinical practice. But who is responsible for ensuring clinicians understand these changes and can apply them appropriately? From maintaining professional knowledge and strengthening clinical evidence to navigating the latest NDIS funding reductions, there are important questions about how we support informed decision-making and advocate for the people who rely on the scheme. Who is responsible for keeping OTs informed about NDIS changes? With NDIS legislation and operational guidance continuing to evolve, maintaining current knowledge is an ongoing responsibility for clinicians working within the scheme. However, the volume and complexity of information can make this difficult to manage independently. Within OT practices, responsibility for monitoring and interpreting changes needs to be clearly allocated. This may sit with a practice owner, clinical leader or another designated team member who can translate relevant developments into practical guidance for clinicians. Regular updates and opportunities to discuss clinical scenarios can help teams apply new information confidently. Without these systems, supervision may become focused on explaining basic NDIS requirements rather than developing clinical reasoning and professional skills. Making professional development meaningful With AHPRA registration renewal approaching, understanding continuing professional development (CPD) requirements is particularly relevant. OTs are required to complete at least 20 hours of CPD annually, including a minimum of five hours of interactive learning with other practitioners. Questions remain about how supervision relates to CPD requirements. While supervision can support professional learning, reflective practice and clinical development, it should not automatically be assumed that all supervision activities qualify as CPD. The nature of the activity and how it meets the Occupational Therapy Board’s requirements need to be considered. Professional development is most valuable when it is planned around identified learning needs rather than simply accumulating hours. Supervision can play a useful role in identifying development priorities and helping clinicians translate new knowledge into meaningful changes in practice. Can your therapy recommendations stand up to scrutiny? Recommending therapy under the NDIS requires more than identifying a participant’s goals and proposing a schedule of intervention. OTs need to demonstrate why the recommended frequency, intensity and duration are appropriate, what outcomes are anticipated and how the intervention will address identified functional needs. Recent ART matters have raised questions about the strength of evidence supporting therapy recommendations. Some clinicians have also been called upon to defend their recommendations through cross-examination, highlighting the importance of being able to clearly articulate the clinical reasoning behind proposed supports. This can be particularly challenging in paediatric practice, where research does not always provide clear guidance on intervention dosage. Rather than relying on established patterns of weekly or fortnightly therapy, recommendations need to reflect individual circumstances, available evidence and professional judgement. Are our OT reports communicating the evidence clearly enough? Detailed clinical descriptions do not always translate into a clear understanding of a participant’s functional capacity, particularly when reports are reviewed by people without a clinical background. Technical terminology and broad descriptions can leave important questions unanswered. Another recent ART matter involving a participant with significant physical impairment demonstrated how photographs could have strengthened the original assessment report. While the clinical descriptions documented substantial limitations, the absence of visual evidence may have made it harder for decision-makers to appreciate the severity of the participant’s functional needs. Clear, specific language and appropriately selected visual evidence can help communicate the practical consequences of impairment. The focus should be on making the evidence meaningful and accessible rather than increasing the volume of information included in a report. When the NDIS safeguards don’t provide the protection you hoped for The introduction of the NDIS Support Determination has created concerns about participants who may experience substantial funding reductions but do not qualify for the available safeguards. For participants with significant support needs, the consequences may not become apparent until their plans are reassessed. A recent case involving a participant with a Positive Behaviour Support Plan and approximately 70 documented behavioural incidents illustrates this challenge. An attempt to have their supports recognised as intensive and complex behaviour supports was unsuccessful, with the NDIA determining that the threshold had not been met. The NDIA also advised that the requested change could not be made through a plan variation. An agreement reached through the Administrative Review Tribunal (ART) process has allowed the participant’s existing plan to be varied without a full reassessment. While this provides some immediate protection, the potential 50% reduction to community participation funding remains a concern when the plan is eventually reassessed. An opportunity to challenge the NDIS funding reductions A Senate disallowance motion concerning the new NDIS funding rules presents an opportunity for the sector to raise concerns about their potential impact. However, with the reforms only recently introduced, there may not yet be enough real-world examples to demonstrate the full consequences. The 50% reduction to social, economic and community participation funding is particularly concerning for participants who rely on substantial daily support. Meanwhile, the 10% reduction to Improved Daily Living Skills funding may be harder to identify, especially where therapy recommendations were already being funded below the amounts requested. Advocacy remains an opportunity for OTs and other stakeholders to communicate the potential consequences of these changes. Sharing specific clinical experiences and examples of participants who may fall outside the safeguards can help demonstrate where the reforms may create unintended outcomes. Key takeaways• OT practices should establish clear responsibility for monitoring NDIS changes and supporting clinicians to apply them• Supervision should not automatically be counted towards CPD without considering the requirements of the relevant professional standard• Planning professional development throughout the year supports more meaningful learning than simply meeting registration requirements• Therapy recommendations should clearly justify the proposed intervention frequency, intensity and expected functional outcomes• OT reports need to communicate functional limitations in language that non-clinical decision-makers can understand• Participants with substantial support needs may still fall outside the NDIS funding safeguards, creating concerns about future plan reductions• The Senate disallowance process provides an opportunity to communicate concerns about the potential consequences of the new funding rules

OT Week is an opportunity to celebrate the profession, but it can also be a time to reflect on how much has changed since we first became Occupational Therapists. The expectations we had, the challenges we faced and the lessons we learnt along the way have all shaped the OTs we are today. Looking back on our early careers can offer a different perspective on professional confidence, the importance of boundaries and the unexpected directions an OT career can take. At a time when many therapists are feeling stretched, it's also an opportunity to reconnect with what makes Occupational Therapy such a rewarding profession. What did being a good OT look like when you graduated? Early career expectations are often shaped by the environments we work in and the therapists we learn from. What constitutes a 'good OT' can look quite different depending on the area of practice. In more structured areas such as occupational rehabilitation, being organised, following through on commitments and managing processes efficiently may be central to how competence is measured. In other settings, the emphasis may be on developing therapeutic relationships, being available to families or demonstrating confidence in clinical decisions. For early career OTs, experienced colleagues can appear to manage everything effortlessly. What isn't always visible are the systems, boundaries and clinical reasoning that have developed over years of practice. Learning that there isn’t always one right answer Receiving feedback can feel particularly personal early in your career, especially when you're still developing confidence in your clinical skills. Even constructive suggestions can be interpreted as evidence that you're not performing well enough. Conflicting feedback from supervisors can also be frustrating, particularly when you're looking for clear guidance on how something should be done. Over time, it becomes easier to recognise that different therapists may approach the same task differently without either approach necessarily being wrong. Observing different therapists and learning from their individual approaches can help develop professional judgement. Rather than searching for one prescribed way of practising, OTs can draw on different perspectives to find approaches that work for them and the people they support. You don't need to know everything One of the biggest lessons that comes with experience is recognising the limits of your knowledge. Early career therapists can feel pressure to appear confident and capable, even when they're unsure of the answer. As professional expertise develops, so does an appreciation of how much there is still to learn. Experience doesn't necessarily mean having every answer, but rather knowing how to approach unfamiliar situations and where to seek support. Being comfortable acknowledging uncertainty, seeking advice and recognising when a referral is appropriate are all part of developing clinical competence. Understanding how you learn best can also make a difference when expanding into unfamiliar areas of practice. The career you never expected to have The career we imagine when graduating may look very different from the one we eventually build. Experience, changing interests and unexpected opportunities can take us into areas of practice we never initially considered. Moving between occupational rehabilitation, hospital settings, disability services and paediatric practice can involve significant changes in how OTs work. Yet the clinical reasoning, communication and problem-solving skills developed in one setting often transfer into another. Career progression doesn't always mean becoming more experienced within the same clinical area. It might involve moving into leadership, education or supporting other therapists, sometimes discovering new professional interests along the way. What would you tell your younger OT self? Looking back on an early career often brings a different perspective on decisions that once felt significant. Opportunities that didn't work out, difficult workplaces and unexpected career changes can all contribute to professional growth. There's also reassurance in knowing that you don't need to have everything figured out when you graduate. Clinical confidence develops with experience, and asking questions or acknowledging gaps in knowledge doesn't make someone a less capable therapist. Learning to establish professional boundaries is another lesson that can take time. Understanding where your responsibilities begin and end, and recognising that another person's crisis doesn't automatically become your own, can help prevent work from consuming your personal life. When you’ve run out of spoons Between clinical responsibilities, administrative work and personal commitments, the demands of Occupational Therapy practice can leave little energy for anything else. Even seemingly small requests can become overwhelming when you're already stretched. Spoon theory offers a way of thinking about our limited daily energy and how different activities affect our capacity. Some tasks require considerably more energy than others, even when they appear relatively straightforward. For OTs, recognising these limits can mean being more selective about professional commitments, setting boundaries around requests and acknowledging when there simply isn't capacity to take on more. NDIS pricing consultation: Have your say The NDIS pricing consultation for 2027–28 is seeking feedback from therapy providers, including questions about pricing arrangements and the financial sustainability of services. The consultation includes several questions specifically relevant to allied health professionals. One area being explored is differentiated pricing for registered and non-registered providers, including potential reductions to the rates available to non-registered providers. Providers are being asked how different pricing scenarios could affect their ability or willingness to continue delivering services. The consultation also asks providers to estimate how much non-face-to-face time is required to deliver therapy services. For OTs and therapy businesses, these questions provide an opportunity to communicate the practical costs of delivering services and the potential consequences of changes to pricing arrangements. A message to the OT community To celebrate OT Week, Occupational Therapists from across Australia contributed messages of encouragement, appreciation and support. Their reflections acknowledge the challenges of working within changing systems and the emotional demands that can accompany clinical practice. Many recognised the creativity, adaptability and advocacy that OTs bring to their work. They also spoke about the difference seemingly small achievements can make to the lives of the people and families they support. The messages encourage therapists to recognise their achievements, protect their wellbeing and remember the value of the relationships they build. At a time when many OTs are feeling exhausted, hearing encouragement from colleagues across the profession offers a different perspective on the work they do every day. Key takeaways • Early career expectations are often shaped by the workplaces, supervisors and therapists we learn from• Different clinical approaches can be equally valid, and professional judgement develops through experience• Knowing when to seek support or acknowledge the limits of your expertise is a professional strength• Occupational Therapy skills are transferable across different areas of practice and career pathways• Difficult experiences and unexpected opportunities can shape professional growth and future career decisions• Establishing boundaries and recognising your energy limits can help manage the demands of Occupational Therapy practice• The NDIS pricing consultation provides an opportunity for therapy providers to communicate the costs and challenges of delivering services Link The NDIS consultation opened on 17 September 2026 and closes on Sunday 1 November 2026: https://www.ndis.gov.au/news/11696-consultation-begins-2027-28-ndis-pricing The review will consider whether current pricing arrangements are providing access to quality supports and services and if any changes are needed for the 2027-28 financial year.

A billable target only tells part of the story. The time needed to complete a report, the travel involved in a caseload and the support available to an early career OT all affect whether expectations are realistic. Fair billing and practical time management sit alongside broader questions about growing a practice beyond its owner. Examples from Freedom Solutions and Freedom Wheels also explore how tailored equipment can help people return to activities they love. Report-writing expectations need to reflect the work A practice owner’s usual report-writing time may not be a fair benchmark for every therapist or assessment. Fixed limits based on how quickly the owner believes they could complete the work can overlook the participant’s circumstances and the complexity of the assessment. Experience also affects efficiency. An early career OT may need considerably longer to complete a report, but there is a distinction between time reasonably charged to the participant and additional time spent learning. Clear expectations need practical support behind them. Showing therapists how to structure reports, use templates thoughtfully and streamline their work gives them a way to improve, rather than simply being told to write faster. What actually counts towards a billable target? An example of an early career OT being asked to achieve 25 billable hours each week, with billable travel excluded from that target, raises questions about how performance expectations are calculated. Some practices count travel at a reduced rate because it generates less income. However, this can create additional workload when therapists need to find more billable activity to meet their target, particularly in regional areas with long distances between appointments. Understanding how a practice earns income is part of working in the private sector, but targets need clear explanations and realistic workload planning. Clustering appointments and reviewing the mix of travel, therapy and report writing can help identify where expectations become difficult to meet. Accurate time recording starts with managing interruptions Time spent on client work can be difficult to reconstruct when reports are interrupted by phone calls, emails and other tasks. Relying on memory makes it harder to distinguish the work completed for each participant. Timekeeping sheets, tracking software or a simple kitchen timer can help record actual work accurately. Pausing when attention shifts elsewhere also prevents unrelated activity from becoming mixed into the time recorded for a report. Protecting concentration matters too. An inbox-hiding browser extension provides one example of how to search for an email without being distracted by new messages and leaving the original task unfinished. Growing a practice means growing the team A service built around one therapist’s reputation can become difficult to expand. If clients expect the owner’s particular approach, bringing in another OT involves more than handing over appointments. Nikki reflects on Action OT’s tenth anniversary, recalling a first referral that involved a Saturday home visit and a report for a man with a brain injury who could not afford an out-of-pocket payment. Only a small Medicare rebate covered the work. Moving from those beginnings to a team-based service requires confidence in the skills of other therapists. Developing staff and communicating the value of the whole practice helps the service become less dependent on one person. Planning an exit starts before you need to leave A busy practice does not necessarily operate independently of its owner. Whether the business can keep running when the owner takes time off is a useful question, particularly when decisions and referrals still depend on them. Selling can also have implications for templates and resources an owner hopes to use in future work. Alyce’s reflection on closing her practice and moving into The OT Coach illustrates how plans for the next stage of a career can influence which exit option makes sense. Assuming a sale will be available when personal circumstances suddenly change can leave owners with limited options. Considering an exit earlier creates more time to review staffing stability, dependence on the owner and what would be included in a potential sale. When standard equipment cannot support a meaningful activity Freedom Solutions’ fiftieth anniversary provides an opportunity to reflect on the collaboration between OTs and volunteer engineers. One example discussed involved developing a tray table when commercially available options would not fit a client’s power wheelchair. Another involved a man who could no longer strum his guitar after a stroke. An adapted device allowed him to return to playing, with further modifications expanding how he could use it. The OT’s contribution is to identify the functional requirements and understand what the person wants to do. Working with an engineer can then help turn those requirements into a tailored solution when standard products are unsuitable. Adaptive bike trials involve more than learning to ride Freedom Wheels clinics support children and adults who have never ridden, outgrown suitable equipment or experienced changes in their function. A young girl riding for the first time and saying, “I doing it”, captures what access to suitable equipment can mean. Different equipment can address different barriers. Examples include wider stabilising outriggers and a pedal-assist trike trialled by a man with multiple sclerosis who wanted to ride with his wife but experienced fatigue. A new folding trike also prompted discussion about transport, given the difficulty of moving larger trikes without a van or trailer. These assistive technology trials have a different purpose from bike skills sessions. In the clinic model described, the participant’s own therapist remains involved in the assessment and recommendation, while the clinic provides equipment knowledge and facilitates trials. Key takeaways• Report-writing expectations should account for assessment complexity and therapist experience, with practical support to build efficiency• Participants should not be expected to fund the additional time an early career OT needs for learning• Clarify how travel contributes to billable targets and consider its effect on the therapist’s actual workload• Record client work as it happens and pause time tracking when interruptions shift attention elsewhere• Growing a practice requires developing the team and reducing dependence on the owner• Consider exit options early, including how a sale could affect resources intended for future work• Tailored equipment and adaptive bike trials can support participation in activities that standard products cannot accommodate LinksARATA Australia Assistive Technology Conference. Register here: https://aatc2026.com

Requests for essential equipment are becoming more complicated when a plan variation is redirected towards a full NDIS reassessment. For some participants, accessing the support they need now may also expose their existing funding to further changes. Understanding these pathways affects how OTs plan assessments, identify future support needs and prepare evidence. Questions around high-intensity supports, the High Support Needs safeguard and the Thriving Kids rollout add further complexity to decisions about funding and service access. Why are equipment requests triggering plan reassessments? Requests for assistive technology (AT) and home modifications are receiving inconsistent responses. Some are progressing as plan variations, while others are being redirected towards full reassessments, including requests for minor modifications such as grab rails. Whether the relevant support category already appears in the plan may be influencing these decisions. A recent example involved an approximately $18,000 manual wheelchair being funded through a variation where the existing plan included an AT category with a zero-dollar allocation. However, the distinction between these pathways remains unclear in practice. A reassessment can have consequences beyond the equipment request, potentially exposing other budgets to funding changes. FCA recommendations should identify foreseeable AT needs, including repairs, maintenance and replacement or hire, and explain the functional and safety implications if equipment cannot be accessed when required. Does seizure management qualify for high-intensity support funding? As participants face funding changes, understanding which exclusions apply becomes particularly relevant. Epilepsy and seizure management appears in the high-intensity support skills descriptor document, but its inclusion does not mean it independently qualifies for the high-intensity support rate. It needs to accompany one of the eight recognised high-intensity descriptors, such as severe dysphagia management or tracheostomy care. Although seizure management can require substantial worker knowledge and skill, that requirement alone does not establish eligibility for the high-intensity rate. When considering exclusions from the funding reset, check the participant’s existing funded line item and the descriptor that applies. Reporting should clearly identify the relevant high-intensity support needs rather than relying on seizure management alone. The safeguard pathway still has practical gaps The High Support Needs safeguard is separate from the high-intensity support descriptors. It provides a pathway for eligible participants to seek additional daily living funding when the funding reset creates a gap in their existing 24-hour support arrangements. The practical application process remains unclear. There does not appear to be a dedicated safeguard form, and conflicting advice about variation and reassessment pathways is making it difficult to establish how requests should be submitted. The wording of the rule points towards a plan variation because it refers specifically to varying the participant’s plan. However, clearer guidance is needed to connect the safeguard requirements with the forms and processes participants are expected to use. An FCA needs a clear purpose before it begins These different funding pathways make it even more necessary to establish what an assessment is intended to achieve. Completing a functional capacity assessment “just in case” can use valuable participant funding, and evidence prepared too early may need updating before it is required. Unscheduled reassessments create a different challenge. A recent CEO-initiated reassessment gave a participant around three weeks to gather evidence, leaving little preparation time. The balance between preparing ahead and preserving funding requires consideration of the participant’s circumstances, likely timing and existing evidence. For a participant-requested early reassessment, the report needs to explain why reassessment is warranted as well as justify the recommended supports. Where functional capacity or informal support arrangements have changed, identify what has changed and why the current plan can no longer meet the participant’s needs. Every part of the report should earn its place Once the assessment’s purpose is clear, the report should stay focused on the evidence needed for that decision. More complex NDIS processes do not automatically require longer reports. A medication list illustrates the difference. Listing every medication and supplement may add little, while explaining that medication-related fatigue increases the assistance required for afternoon tasks provides relevant functional evidence. Historical information should be considered in the same way. Standardised assessment results also need interpretation. Explain what the findings mean, whether they align with observation and reported function and how they inform recommendations. An FCA is a point-in-time functional assessment, so information gathering should remain focused on its purpose rather than expanding into every possible area of therapeutic assessment. Thriving Kids: what support is actually available? For families of children with disability, uncertainty extends beyond changes to existing NDIS plans. The initial Thriving Kids developments include an autism information helpline delivered by Amaze and an online resource hub, but these do not resolve the question of where families can access targeted therapy and support. Details about the wider rollout remain limited, particularly around local providers and service pathways. Practices are also reporting different experiences of NDIS access and funding changes, with substantial caseload impacts in some services and little apparent change in others. While alternative pathways remain unclear, families seeking NDIS access still need support to navigate the early childhood partner process. For children already receiving NDIS supports, decisions about assessment and therapy should consider the purpose of each service and how it will use the funding available. Making space to recognise the profession Professional awards provide an opportunity to recognise OT work and learn about achievements across allied health. They also make visible work that may otherwise remain largely within individual practices or local communities. Rural and remote services are one area where valuable OT contributions deserve broader recognition. Sharing this work can help others understand the practical challenges, service innovations and outcomes being achieved outside larger professional networks. OT Week offers another opportunity to connect, particularly for sole practitioners who may not have a workplace celebration to attend. Organising a local gathering or joining other OTs creates space to recognise the profession and the people doing the work. The safeguard pathway still has practical gaps The High Support Needs safeguard is separate from the high-intensity support descriptors. It provides a pathway for eligible participants to seek additional daily living funding when the funding reset creates a gap in their existing 24-hour support arrangements. The practical application process remains unclear. There does not appear to be a dedicated safeguard form, and conflicting advice about variation and reassessment pathways is making it difficult to establish how requests should be submitted. The wording of the rule points towards a plan variation because it refers specifically to varying the participant’s plan. However, clearer guidance is needed to connect the safeguard requirements with the forms and processes participants are expected to use. Key takeaways • Inconsistent variation and reassessment responses can complicate access to essential AT and home modifications• Identify foreseeable equipment needs and explain the risks if equipment is unavailable• Epilepsy and seizure management alone does not qualify for the high-intensity support rate• Clearer application guidance is needed for the High Support Needs safeguard• Clarify the purpose, timing and available funding before commencing an FCA• Keep reports focused on functional evidence and clearly explain the reasoning behind recommendations• Thriving Kids information services leave ongoing questions about access to targeted supports and local service pathways

The NDIS funding reset is here, and for OTs the implications go well beyond understanding the percentage reductions. There are questions about who will be affected, what happens when funding is reduced and what evidence may now need to be captured. The new Support Determination, High Support Needs safeguard and exclusions for certain supports have practical implications for OT assessment, reporting and service delivery. There is also the challenge of supporting participants and families through changes that may significantly affect their everyday supports. What does the funding reset mean in practice? From 1 October 2026, the funding reset applies to relevant new or reassessed plans, with a 50% reduction in accessible Social, Economic and Community Participation funding and a 10% reduction in Improved Daily Living. This could mean substantially less funding available for community participation and reduced therapy budgets. The changes are relevant across both adult and paediatric practice, including participants accessing Allied Health and community supports. The changes will be introduced progressively, with plan renewals also affected from 1 February 2027 and the reset intended to apply across participant plans by September 2027. What happens when the reduction creates a support gap? The High Support Needs safeguard provides a potential plan variation pathway where the funding reset creates a gap in a participant’s ability to safely receive 24-hour disability supports. Eligibility requires NDIS-funded disability supports across 24 hours and the relevant annual funding threshold to be met. The previously referenced 1:3 support ratio is not a separate eligibility criterion. The pathway does not simply reinstate the Social, Economic and Community Participation funding that has been reduced. Instead, a variation may provide additional Assistance with Daily Life or Home and Living funding to address the resulting gap in 24-hour supports. A significant concern remains for participants who require support across 24 hours but do not currently receive NDIS-funded disability supports across the full 24-hour period. This may include participants whose family members provide substantial support during currently unfunded hours. Which supports are protected from the 50% reset? Not all Social, Economic and Community Participation supports are subject to the 50% reduction. Excluded support subgroups include specialised supported employment, eligible high intensity supports and intensive and complex behaviour supports. For OTs, this makes accurately identifying and evidencing the type of support a participant requires particularly relevant. A participant may have needs consistent with high intensity supports while their existing plan has been built using standard support line items. High intensity support needs may include areas such as epilepsy and seizure support, complex bowel care, dysphagia support, diabetes management, enteral feeding and tracheostomy care. Appropriate evidence of the support required, including relevant management plans, may need to accompany these recommendations. Similarly, having a behaviour support plan does not automatically establish a need for intensive and complex behaviour supports. Functional evidence should clearly demonstrate the behaviours of concern, their impact on safety and wellbeing and the level of support required. Working differently with reduced funding For therapy, a 10% reduction does not necessarily mean simply reducing every service by 10%. Looking at the available funding across the full year may create more flexibility in how intervention is delivered. This could include changing session frequency or length, using blocks of intervention, incorporating telehealth or coaching where appropriate or prioritising particular aspects of a participant’s goals. Any changes still need to reflect the participant’s assessed needs and the potential impact of reduced intervention. There may also be efficiencies to find within OT practice. Streamlining assessment processes, reducing duplication in reports and improving templates may help make better use of available funding without compromising clinical reasoning or the evidence required. When you can’t change the outcome There is also a significant emotional impact for OTs navigating these reforms alongside participants and families. One client example involved achieving a positive outcome through the ART, only for the prospect of the new plan being affected by the funding reset to create another major challenge. This raises the issue of moral injury, particularly when clinicians can see the potential consequences of a system decision but have limited ability to change the outcome. Supervision, psychosocial safety and appropriate support for clinicians become increasingly relevant when OTs are having difficult conversations with participants and families while also managing their own response to changes outside their control. Key takeaways • The funding reset affects both community participation and therapy funding, with changes being introduced progressively • The High Support Needs safeguard may provide a plan variation pathway where the reduction creates a gap in safe 24-hour disability supports • Participants who need 24-hour support but do not receive NDIS-funded disability supports across the full 24 hours remain a significant concern • Some eligible high intensity and intensive and complex behaviour supports are excluded from the 50% reduction • OTs may need to strengthen how high intensity and complex support needs are identified and evidenced within Functional Capacity Assessments • Reduced therapy funding may require different approaches to service delivery and greater efficiency within OT practice • Supervision and psychosocial safety are increasingly relevant as OTs navigate the professional and emotional impact of these changes

From 1 October, new NDIS funding changes will affect how some participants can access funding for social, community and civic participation. The detail OTs have been waiting for around the safeguard for participants with high support needs has now been released. The guidance provides a pathway for some participants whose funding reset leaves them without enough funding to maintain their 24-hour disability supports. But the eligibility criteria create a significant gap: needing 24-hour support is not necessarily enough. The participant must already receive 24-hour funded NDIS supports. Who qualifies as a high support needs participant? To access the new safeguard pathway, participants must meet specific criteria relating to their existing plan funding and support arrangements. The guidance describes a high support needs participant as someone with a relevant total budget of at least $215,000 before the funding reset, who receives 24-hour funded NDIS supports for needs arising directly from their disability and receives those funded supports at a shared ratio of at least 1:3. The wording around funded NDIS supports is particularly significant because it determines who can access the safeguard when their funding is reduced. Required support and funded support are not the same thing A participant may require support 24 hours a day without currently receiving 24 hours of formal NDIS-funded support. Consider someone who cannot safely be left alone but lives with family. Support workers may assist with personal care in the morning, the participant may attend a day program and family may provide support during evenings and overnight. Their disability-related need for support exists across the full 24 hours. The difference is that some of those hours are currently being provided by parents, partners or other informal supports rather than funded through the NDIS. Under the new criteria, this distinction will determine whether the participant has access to the safeguard. The bad news?  The above mentioned participants will not.  What happens if they don’t meet the criteria? If community participation funding is reduced, participants relying partly on informal supports will find themselves in a difficult position. They won't meet the High Support Needs criteria because they do not currently receive 24-hour funded NDIS supports, even though they cannot safely be left without support. The funding reduction itself also does not necessarily represent a significant and ongoing change in functional capacity, support needs or circumstances that would provide another straightforward pathway to an unscheduled plan reassessment. This leaves an important question about what happens when formal community supports are reduced and family is already providing the support required during the remaining hours. There are no clear answers to this. For eligible participants, what does the safeguard actually provide? The guidance provides an example of a participant whose social and community participation budget reduces from $150,000 to $75,000, leaving insufficient funding to maintain their previous 24-hour support arrangements. Through the safeguard pathway, additional funding may be added to daily living supports to address the resulting support gap at home. However, this does not necessarily restore the participant’s previous level of community participation. Instead, funding may be redirected towards the support required while the participant remains at home. The safeguard therefore addresses a potential gap in 24-hour support, but it does not necessarily replace the community participation opportunities lost through the funding reduction.   The variation process could create another support gap Timing creates a separate practical issue for participants who do qualify for the safeguard. Participants have 90 days to request the variation. The Agency then has 21 days to determine whether the participant meets the High Support Needs definition. If they do, they have a further 21 days before a decision is made about varying the plan. This creates the possibility of a gap between reduced funding taking effect and additional daily living funding becoming available. For participants receiving SIL supports through monthly funding periods, this could also create practical difficulties for providers expected to maintain safe support arrangements while the variation is being considered.   The importance of early identification of participant criteria Given the above timeframes and high risk to participant safety and well-being, timely provision of reporting to evidence eligibilty for the High Needs Support Safeguard is essential.   To aid Occupational Therapists in preparing reporting to address this, we have created an editable template to either insert into their current FCA reporting or provide as an addendum report.   Access the framework template here: INSERT LINK Key takeaways for OTs  • The High Support Needs safeguard has specific eligibility criteria, including requirements around 24-hour funded NDIS supports • Requiring 24-hour support and receiving 24-hour funded support are not the same thing • Participants relying on family to provide part of their 24-hour support may fall outside the safeguard pathway • For eligible participants, the safeguard may redirect funding towards daily living support rather than restoring previous community participation funding • OT reporting should clearly distinguish actual disability-related support needs from the amount of formal support currently funded • The timing of the variation process may create additional challenges for participants and providers while decisions are being made   Links High Support Needs Safeguard Info, released 22rd September 2026: https://www.health.gov.au/resources/publications/ndis-funding-changes-high-support-needs-safeguards?language=en High Support Needs Safeguard Info, released 23rd September 2026: https://www.health.gov.au/our-work/ndis-legislation-changes/amendments/funding-changes-for-ndis-supports?language=en&fbclid=IwdGRleAUgLjRwZG9mBWZkaWQWUO88wjK41vlh4a2RhNo7m1ODdX5SmWV4dG4DYWVtAjExAHNydGMGYXBwX2lkCjY2Mjg1NjgzNzkAAR71jgOkSuL5QanyhR8LgE-8ZBblHA27CnQkyxSwU4kKG_E7uzTQhDmeiySy9w_aem_aV9hx-NIV-kXaE_OlzzaEQ

Some moments in your OT career stay with you. A decision, a client or even a comment from someone else can change the direction of your career or the way you think about your role. This week, Sarah, Alyce and Nikki share some of their own ‘sliding doors’ moments, from career decisions that changed their direction to clinical experiences that reshaped how they understood their role as OTs. They also unpack recent NDIS developments around students on placement, functional capacity and changes approaching from 1 October. The career decisions that change everything Sometimes a career-defining decision starts with realising it is time to leave. Sarah reflects on the workplace experience that ultimately gave her the push to step away from a role she once thought she would never leave and start Verve OT. Alyce shares turning points of her own, including professional development that challenged the way she thought about clinical intervention and a period away from Occupational Therapy that ultimately led her back to the profession and into building her own practice. Looking back, neither could have known exactly where those decisions would lead. Sometimes it is only years later that you can see how one choice changed the trajectory of your career. When you can’t change the outcome Nikki shares the story of a man with rapidly progressing motor neurone disease who desperately wanted to leave hospital and return home. After considerable work to organise equipment and make his discharge possible, he made it home on a Friday afternoon and died the following day. At first, Nikki felt that everything they had done had made no difference. Her manager helped her see it differently: they could not change the fact that he was dying, but they had changed his experience by helping him spend that final time at home. That moment changed Nikki’s understanding of what making a difference can look like and influenced her later work in palliative and end-of-life care. It also highlights the role good supervision can play in helping OTs process difficult experiences and make sense of what they mean for their practice. The small things can be the big things Not every meaningful OT outcome looks impressive on paper. Nikki shares how one family still considers a simple toilet rail one of the most valuable things she has done for them, despite years of other intervention. Sarah recalls a client telling her that the biggest thing she had provided through a home modification process wasn’t the modification itself. It was hope that life might become easier. These moments are a reminder that OTs don’t always know which part of their work will matter most to someone. Particularly as service systems and funding models change, recognising these smaller wins can help keep the focus on what can make a meaningful difference for the person in front of us. Can you bill for students on placement under the NDIS? New NDIS guidance has raised fresh questions about students on placement. Earlier guidance stated that allied health students could deliver specific supports under supervision but that their work could not be directly claimed because placements were unpaid educational opportunities. The current NDIS guidance says allied health students and provisional psychologists can provide services under the supervision of a qualified allied health provider, with participant agreement. It also says service agreements should outline how the arrangement could provide greater flexibility, such as a lower hourly rate or additional service hours. What remains less clear is exactly how those services should be billed. The wording appears to have shifted again, but there is still enough ambiguity that providers will need to consider how they interpret and apply the guidance in practice. A changing definition of functional capacity A recent SDA matter prompted questions about how the amended definition of functional capacity is already being applied under the NDIS. The definition considers a person’s ability to undertake an activity without assistance from other people or assistive technology, with particular provisions around commonly used AT and assistance for children. This raises questions about what the definition could mean when considering the functional impact of disability. There is still more to unpack about how this will be applied in practice, particularly for OTs completing functional capacity assessments. It is an area to watch as further information becomes available. What’s changing from 1 October? There is plenty for allied health providers to have on their radar as 1 October approaches, including changes to classifications under the Health Professionals and Support Services Award and the upcoming ban on card surcharges. Thriving Kids activity is also expected to begin in New South Wales, although there are still questions around exactly how and when service pathways will roll out. For NDIS providers, there is also uncertainty around upcoming support determinations and what the high needs pathway will look like. With several changes happening at once, OTs and business owners will need to stay across further guidance as it becomes available. Key takeaways • Career-defining moments can come from unexpected decisions, challenges and clinical experiences• Good supervision can help OTs reflect on difficult experiences and shape their future practice• Small interventions can have a significant impact, even when they seem simple from an OT perspective• NDIS guidance around students on placement has changed again, but questions remain about how services can be billed• Changes to the definition of functional capacity may have implications for OTs completing functional capacity assessments• Several changes are approaching from 1 October, including award classifications, card surcharges and NDIS support determinations Links Guide to working as an allied health provider: https://www.ndis.gov.au/providers/working-participants/allied-health-professionals/guide-working-allied-health-provider

The NDIS support lists have only been in place since October 2024, but another significant change may already be on the horizon. A new consultation is considering how NDIS supports should be defined, including proposals to reduce the number of support categories, simplify their descriptions and remove the replacement supports process. For OTs, some changes could make the rules easier to interpret. Others raise questions about what happens when an everyday product is also the simplest solution to a disability-related functional need. Why is the NDIS support list changing? The current support lists were introduced in October 2024 as transitional rules defining what participants can and cannot generally spend NDIS funding on. Feedback has highlighted several problems, including confusing categories, unclear descriptions and difficulties understanding replacement supports. The proposal is to reduce 36 support categories to 18 broader categories, with simpler purpose-based descriptions and examples. These categories are also being developed to align with new framework planning and the introduction of support needs assessments. Replacement supports could disappear One of the biggest proposed changes is the removal of the replacement supports process. Tablets, smartphones, smartwatches and accessibility or communication apps have been among the most commonly requested replacement supports. The proposal is for these types of supports to instead become stated supports where the relevant requirements are met. This could create a clearer pathway for some disability-related technology. The bigger question is what happens to other products currently considered through replacement supports. What happens to everyday products that solve disability-related problems? Mainstream products do not always have mainstream purposes. Consider a person with a spinal cord injury who can put clothing into a top-loading washing machine but cannot independently retrieve it. A front-loading machine could remove that functional barrier and allow them to complete their washing independently. Similar questions arise with robotic vacuum cleaners, food preparation appliances and other household products. Sometimes a readily available mainstream product is the simplest and most cost-effective way to address a functional need. Removing replacement supports could therefore have consequences beyond simplifying an administrative process. The detail of what remains fundable, and through which pathway, will matter. Some disputed supports could move firmly onto the ‘out’ list The consultation also identifies products and services where there has reportedly been confusion about whether they are NDIS supports. These include electronic noise-cancelling headphones, fencing and gates, hairstyling tools, hydrogen fuel and electric vehicle charging costs and scuba therapy. The proposal is to specifically exclude them. Noise-cancelling headphones are particularly relevant to OTs because they may be recommended to address sensory needs and support functional participation. This also highlights why looking only at the proposed funded categories does not tell us everything. A product might appear to fit within a broad support definition but still be unavailable if it is specifically excluded elsewhere. The new categories could make some OT roles clearer There are areas where the proposed definitions provide welcome clarity. The proposed therapy supports category specifically includes assessment by allied health professionals for support planning and review. It also captures assessment, prescription, implementation, adjustment and training in the use of assistive technology where required to support functional outcomes. Home modifications similarly include the design, planning, implementation and review of modifications, alongside maintenance and repair of disability-specific fixtures and modifications. Assistive technology categories are also being consolidated. While there would be fewer overarching categories, detailed descriptions would continue to sit beneath them, so fewer categories will not necessarily mean less complexity. These changes are part of a much bigger planning reform The support list changes cannot be considered separately from new framework planning. Under the future model, a support needs assessment will play a central role in determining a participant’s budget. The proposed support categories are being designed to align with this new approach. This means the practical impact of the support list will depend on more than which category a support sits within. It will also depend on how needs are assessed, how budgets are determined and how participants can use those budgets. Further consultation on the new framework planning rules should provide more detail about how these pieces will work together. Why OT input into the consultation matters Funding rules can appear straightforward on paper but work very differently when applied to someone’s actual function, environment and daily occupations. OTs regularly see where a mainstream product becomes an assistive solution, where a seemingly clear category creates ambiguity and where funding rules affect the practical options available to a participant. That experience can help identify unintended consequences before proposed rules become established practice. The consultation provides several ways to contribute, including making a submission, providing a video response, responding by email or requesting a phone call. Key takeaways for OTs * The NDIS is proposing to reduce 36 support categories to 18 broader categories* The replacement supports process could be removed* Some commonly requested technology may instead become stated supports where requirements are met* The future of other mainstream household products currently considered through replacement supports needs close attention* Electronic noise-cancelling headphones are among the supports proposed for specific exclusion* The new support list is being developed alongside new framework planning and support needs assessments These are still proposed changes. For OTs, now is the time to look beyond whether the new categories appear simpler and consider how they could work when applied to real functional needs and everyday recommendations. New Framework Planning and NDIS Supports Consultation: https://consultations.health.gov.au/disability-and-carers-group/nfp-ndis-supports/ OT Unplugged Competition Entry Form: https://www.verveotlearning.com.au/ot-unplugged-competition-sit-at-our-table

NDIS reporting is changing, but one question remains fundamental for Occupational Therapists: why are we including this information? Longer reports and more assessments do not automatically create stronger evidence. A useful NDIS OT report needs to demonstrate a participant’s functional needs, connect those needs to their goals and clearly explain why recommended supports are required. This means moving beyond clinical terminology and assessment scores towards evidence that helps the reader understand what everyday life actually looks like for the participant. Understand why the report is needed Before beginning an assessment, Occupational Therapists need to understand why the report has been requested and what decision it is intended to inform. A plan reassessment based on a change in circumstances requires evidence of a significant and ongoing change. This may involve changes to functional capacity, informal supports or broader life circumstances. That is different from a situation where a participant believes their existing plan was underfunded. Understanding this distinction early can help avoid spending valuable participant funding on a comprehensive assessment that does not address the issue at hand. Good onboarding is essential. Clarify what the report is for, what evidence already exists, who else is involved and what information is actually required. Show what function looks like in everyday life Once the purpose of the report is clear, the next priority is showing what the participant’s functional needs actually look like. Occupational Therapists understand terms such as dysregulation, co-regulation, executive functioning and fine motor difficulties. The person reading an NDIS report may not interpret those terms in the same way, so clinical terminology needs to be connected to specific, functional examples. If a participant became dysregulated during an assessment, what did that look like? What happened and what support did they require? If they have reduced fine motor coordination, how does this affect dressing, eating, handwriting or another meaningful activity? This is where both top-down and bottom-up thinking have a place. Identifying an impairment such as reduced grip strength, balance or fine motor coordination can provide valuable clinical evidence, but the report also needs to explain what that impairment means for everyday participation. Functional examples bring the reader into the assessment and make the impact of disability easier to understand. Choose assessments that add meaningful evidence With the functional picture established, consider what additional evidence is actually needed to support your clinical reasoning. Standardised assessments remain an important part of Occupational Therapy practice, but not every available assessment belongs in every NDIS report. Ask: what additional evidence will this assessment provide? A standardised assessment may validate observations, establish a baseline, support clinical reasoning or provide an outcome measure. In those circumstances, it can be extremely valuable. However, completing multiple assessments can consume significant participant funding without necessarily changing the recommendations. The same principle applies to presenting results. Pages of graphs, tables and scores can make a report longer without making it clearer. Often, the Occupational Therapist’s interpretation is more valuable. Explain what the assessment showed, whether it aligned with other evidence and how the findings informed your recommendations. Consider value for money Being selective about assessment also means considering how participant funding is being used. A useful question is whether you would feel comfortable asking someone to pay privately for everything you are proposing. This does not mean compromising evidence-based practice or avoiding comprehensive assessment when it is genuinely required. It means being intentional about what each component contributes. If observation, interview, existing reports and one carefully selected assessment provide sufficient evidence, adding several more assessments may not improve the outcome. Good clinical reasoning is demonstrated by choosing the right assessment methods and interpreting them well, not by using the greatest number of tools. Make recommendations specific and defensible The evidence gathered throughout the assessment should lead logically into clear recommendations. Simply stating that a participant requires a certain number of support worker hours leaves important questions unanswered. What will the support worker assist with? When is the assistance required? Is the support needed at home or in the community? Is it required during weekdays, evenings or weekends? These details demonstrate how the recommendation was calculated and why the support is necessary. Recommendations should also reflect the participant’s assessed needs rather than a provider’s rostering arrangements. If a participant requires one hour of assistance, the Occupational Therapist’s recommendation should reflect that need rather than being increased because of a provider’s minimum shift requirements. The aim is to make the connection between functional need, required support and recommendation as clear as possible. Stay within Occupational Therapy scope Specific recommendations also require Occupational Therapists to be clear about where their professional scope begins and ends. If an Occupational Therapist identifies a likely need for physiotherapy, speech pathology or another discipline and that professional is not yet involved, it may be appropriate to recommend funding for an assessment. Prescribing another profession’s ongoing therapy hours without their assessment is different. Support worker recommendations sit more directly within Occupational Therapy scope because assessing the assistance a participant requires to complete everyday activities is a core part of functional assessment. Know when a full reassessment isn’t necessary Providing strong evidence does not always mean completing another functional capacity assessment from scratch. If a comprehensive assessment was completed relatively recently and most of the participant’s function remains unchanged, an addendum or supplementary report may provide what is needed. The Occupational Therapist can explain what has been reassessed, identify what has changed and confirm which previous findings remain current. The original report can then accompany the supplementary evidence. This can provide the required information without unnecessarily using participant funding or repeating work that has already been completed. Better reports are not necessarily longer Every assessment, paragraph, graph and recommendation should earn its place in an NDIS OT report. Ask whether it helps explain the participant’s function, strengthens the evidence or supports the clinical reasoning behind a recommendation. The goal is not to create the longest report possible. It is to give the reader a clear and accurate picture of the participant’s everyday life and make the reasoning behind each recommendation easy to understand. Key takeaways for OTs ◆ Clarify why the report is being requested before beginning the assessment◆ Keep everyday function at the centre of your evidence◆ Use specific examples to translate clinical terminology into functional impact◆ Choose assessments according to the meaningful evidence they add◆ Interpret assessment findings rather than relying on pages of scores and graphs◆ Make recommendations specific about what support is required, when and why◆ Recommend according to the participant’s assessed needs rather than provider rostering requirements◆ Stay within Occupational Therapy scope when discussing other health professionals’ services◆ Consider an addendum or supplementary report when a full reassessment is unnecessary Links OT Unplugged Competition Entry Form: https://www.verveotlearning.com.au/ot-unplugged-competition-sit-at-our-table Australian Assistive Technology Conference (11 Nov - 13 Nov) https://www.arata.org.au/aatc/aatc-2026/