Why ASD Level 2 May No Longer Meet NDIS Eligibility Requirements

The National Disability Insurance Scheme (NDIS) is a cornerstone of support for Australians with disabilities, including those diagnosed with Autism Spectrum Disorder (ASD). However, recent changes in eligibility criteria have sparked concern and anxiety for many NDIS families, particularly regarding ASD Level 2. Here’s an in-depth look at why ASD Level 2 may no longer meet NDIS eligibility requirements since the legislation changes came into effect on 3 October 2024.

Understanding ASD Levels

In 2013 the fifth edition of the handbook used to diagnose mental disorders, including autism was released.  It is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and is used by appropriate medical or allied health professional to make formal diagnoses.

Under DSM-5, ASD is categorised into three levels based on the degree of support needed.   Broadly speaking these are:

  • Level 1: Requiring Support
  • Level 2: Requiring Substantial Support
  • Level 3: Requiring Very Substantial Support

People with an ASD diagnosis can require different levels of support for:

  • Social communication, and
  • Restricted, repetitive behaviours.

When the NDIS legislation was written (back in 2012ish), most people with a diagnosis of Autism were diagnosed using the criteria outlined in DSM-4 (or DSM-IV-TR).  DSM-4 included differential diagnoses for high functioning Autism (Aspergers) and those with the most profound functional impact. There is a general perception that a DSM-4 diagnosis of Autism and a DSM-5 diagnosis of ASD2 line-up perfectly, but this is not the case.

At PlanHELP we have seen many dozens of documentation FOI’d (obtained via freedom of information) from the NDIS including eligibility decisions. In all instances of a diagnosis of ASD 2, the eligibility decision tree was “ineligible overridden by List A and B”. After the legislation change this cohort is likely to be targeted for the reassessment process.

Navigating the changes in Eligibility Criteria

The NDIS eligibility criteria are periodically reviewed to ensure that the scheme is operating within scope and intent and ensure it remains financially sustainable and effective. Recent legislation changes have led to stricter guidelines, particularly for conditions listed under List B, which includes ASD Level 2.

  1. Functional Capacity Assessment: The NDIS now places greater emphasis on functional capacity rather than just the diagnosis. This means that individuals with ASD Level 2 must provide detailed evidence of how their condition impacts their daily life and functional abilities, taking into account that the NDIS is designed to support those with severe and profound disability related support needs.
  2. Evidence Requirements: There is a higher burden of proof for ASD Level 2 applicants. They must submit comprehensive reports from healthcare professionals, including psychologists and occupational therapists, demonstrating the substantial support needed. In our experience many NDIS participants/nominees believe they have a very strong evidence base. When looked over by an expert eye that has reviewed 10,000’s of allied health reports completed by 1000s of allied health and medical professionals, it is clear that many people do not have the calibre of evidence they believe they have.  Research out of the NDIS Quality and Safeguards Commission (released 2022) indicates that a significant proportion of Behaviour Support plans and reports are not fit for purpose. Over 4 years PlanHELP has assisted 100s of families link with allied health professionals who can meet the evidence requirements of the NDIS.
  3. Consistency and Fairness: The changes aim to ensure that the NDIS supports those with the most significant and permanent disabilities and is put on a financially sustainable footing. By requiring more rigorous evidence, the NDIS seeks to maintain fairness and equity across all eligible NDIS participants.

Impact on ASD Level 2 Applicants

Individuals with a diagnosis of ASD Level 2 must now undergo a more thorough assessment process by appropriate allied health professional and appropriate diagnosis information to demonstrate their ongoing need for substantial support. This can be challenging and may result in some individuals not meeting the revised criteria who with the solid set of documentation would have maintained eligibility.

The shift in NDIS eligibility criteria for ASD Level 2 reflects a broader effort to ensure the scheme’s sustainability and fairness. While this may pose challenges for some applicants, it underscores the importance of providing detailed and accurate evidence of the impact of ASD on daily life. For those navigating this process, seeking guidance from medical and allied health professionals and staying informed about NDIS requirements is crucial.

Disclaimer: PlanHELP pride ourselves on being thought leaders in the NDIS space. PlanHELP does not speak on behalf of the NDIS, and often our message is quite diBerent from the NDIS message. Our track record for staying a couple of steps ahead is consistent. If you want to be told everything is all positive, or ignore the changes until they directly impact you, your family or your business these are not the articles for you. We suggest you stick with Facebook and other social media as your source of information. If your goal is to be two steps ahead and you treat the NDIS as your professional hobby, PlanHELP can provide a unique perspective that will assist you to look at the NDIS diBerently. planHELP assist decision makers through training and consultancy to minimise the impact changes within the NDIS have on you, your family or business. PlanHELPs key consultants have spent tens of thousands of hours gaining expertise of the NDIS to support families and businesses on their NDIS journey and have a track record second to none. Read our articles then pay attention to what we, and others, are saying and decide for yourself which companies and professionals are able to keep you well informed of the changes that are rapidly occurring within the NDIS.