S8E01 – New Year, New Pressures: What the Pricing Consultation Means for OTs

Many OT teams are feeling the same mix right now – strong referral demand alongside shifting rules and inconsistent NDIA decision making. It’s hard to plan services, hard to train early career clinicians and hard to give participants confidence when the system keeps changing.

At the same time, participants are increasingly experiencing funding reductions rather than exits from the scheme. That shift raises the stakes for functional evidence, because strong documentation can be the difference between maintaining essential supports and losing them.

Funding cuts are changing what participants need from us More participants are reporting plans that don’t reflect the evidence submitted, even when assessments are clinically sound. This creates frustration for families and clinicians alike. Plus, it increases the emotional load of practice.

In paediatrics, the impact can be particularly severe when a young person finishes school and ages out of paediatric pathways. Families are often told updated diagnoses are required, despite limited public access and significant private costs, leaving young people with genuine functional needs but minimal funded support.

Why the pricing consultation matters right now Against this backdrop, the NDIA pricing consultation is one of the few formal opportunities therapy providers have to influence decisions that shape workforce sustainability and participant access. Historically, therapy provider engagement has been low, making it easier for pricing decisions to rely on limited feedback or flawed proxy data.

Previous reviews have drawn heavily on publicly listed website fees and comparisons with Medicare and private health insurance. These approaches often miss the context of session length, bundled inclusions and the administrative work required for ethical NDIS practice.

Differentiated pricing is the central issue The main focus of the consultation is differentiated pricing, where different price limits may apply under different conditions. Factors being considered include provider registration status, participant complexity, workforce qualifications, geographic location, service quality metrics and provider size. The biggest risk is reduced access. If lower price tiers apply to some participants or contexts, providers may avoid that work because the time and overheads don’t reduce with the rate. An hour is still an hour, regardless of the participant category.

There is also a workforce risk. If higher rates are tied to complexity, the system needs enough clinicians with the skills, experience and supervision to meet that demand. Without this, services may cherry pick or push clinicians into work they are not adequately supported to manage.

Quality and supervision are harder to define than they appear “Quality investment” sounds straightforward until it has to be measured. Supervision is a good example. Safe practice is often built through ongoing informal support such as joint visits, quick consults and clinical reasoning discussions, not just a scheduled weekly meeting.

If differentiated pricing is linked to quality metrics, providers need to clearly articulate that meaningful quality requires robust definitions and safeguards. Otherwise, quality risks becoming a checkbox rather than a protection for participants and clinicians.

Travel remains a major gap in the consultation Travel is barely addressed in the therapy section, despite being a significant pressure point in recent NDIS changes. For many supports, travel is not optional – it is integral to delivering effective intervention, particularly for home modifications, assistive technology trials and context-based therapy.

Any further tightening of travel rules will disproportionately affect participants outside major cities and those whose goals rely on environmental assessment. Even without a direct question, travel should be raised in the open response section or a written submission.

What the session length question is really