When physiotherapist Kate Caldow was asked how she's feeling about the future, her eyes welled up with tears. "We're all feeling a bit down, a bit deflated, a bit under-valued," Ms Caldow said. "And we're having to make really tough decisions." Ms Caldow is one of a number therapy support providers in Canberra struggling to make sense of the National Disability Insurance Agency (NDIA's) latest annual pricing review. From July 1, the fee for physiotherapy services will be capped at $183.99 per hour, marking a $10 reduction. Dietitian and podiatry appointments will be capped at $187.99 per hour, marking a $5 reduction. And travel subsidies for allied health professionals will be cut in half. Regular therapy support difficult in regional towns Ms Caldow opened Country Children's Physiotherapy in Belconnen almost a decade ago with the goal of ensuring children living in regional towns surrounding the ACT had access to good quality care. Hayden Traynor fits that exact bill. The six-year-old, who lives in Booroowa, was diagnosed with cerebral palsy after having a stroke at just three months old. Regular physiotherapy has been key to helping Hayden overcome those challenges and has helped him to learn to walk, dress himself and make his own breakfast. Once a week, a physiotherapist or allied health assistant from Ms Caldow's team visits Hayden at home or at school. His speech pathologist also travels to Booroowa for appointments, and he sees an occupational therapist in Canberra. "I think he'd be completely [incapacitated] without all of the intervention we've done," Ms Moorby said. "We were lucky enough to get streamlined on to the National Disability Insurance Scheme (NDIS) early." 'Heartbreaking, gut-wrenching' decision Hayden's physiotherapy visits are now seriously in doubt, with Ms Caldow grappling with the prospect of scaling back her team's travel on account of the looming pricing changes. NDIS participants currently make up around 75 per cent of her clinic's clients. "We travel to Booroowa, Gunning, Gundaroo, Harden, Collector — all the areas around Canberra," she said. "For some parents, especially those with children with high needs, it's so hard to come and see us and there are no providers in these areas. "That's an awful decision to be making. It's heartbreaking, gut-wrenching." The risk for Hayden, if he were to go without regular physiotherapy, is significant. "If there's no intervention, he's likely to end up in a ball due to tightening muscles," Ms Caldow said. "That will impact his ability to function, his ability to walk and his ability to use his arm." Constant battle for adequate support exhausting Ms Moorby will do whatever it takes to prevent her son from missing out — including making the three-hour round trip to Canberra — but admitted the constant battle for adequate support was exhausting. "I'd do anything for my children, but it's been an uphill battle from the beginning with Hayden so to find out we have another challenge in front of us, it's just really hard," she said. "And it's like it's targeted at us. We already miss out on so much living in a country town and now they're taking this away from us as well." In a statement to the ABC, a spokesperson for the NDIA described the caps to hourly rates as "modest". "It's important that NDIS participants are paying prices that are fair and in line with industry standards," the spokesperson said. "In some cases, NDIS price limits exceeded the market rate by up to 68 per cent." The spokesperson also said the changes to travel claims were in direct response to feedback from NDIS participants. "The updated travel therapy claiming rules encourage more efficient scheduling by providers and provide clear cost expectations for participants to help them get better value from their funding." Seventh year without occupational therapy pricing increase Like most five year olds, Jon Beit loves Bluey, trains and playing in playgrounds. But unlike most other children his age, Jon requires an array of equipment to do the things he loves. He also relies on equipment to move, eat, sleep and shower. "Jon lives with a genetic condition called spinal muscular atrophy," his mother Megan Beit said. It's occupational therapist Kat Senger who has been there every step of the way — picking the appropriate equipment and ensuring it's correctly fitted at home and school. Her Canberra clinic, Little Hands OT, is focused on children with high, complex needs, with NDIS participants accounting for 95 per cent of her client base. The latest NDIA pricing review delivered her an unwelcome blow. "Before these changes, I would say we were surviving, not thriving," Ms Senger said. Although occupational therapy won't see a reduction in pricing caps, it will endure a seventh year without a pricing increase from $193.99. Halved travel subsidies increase pressure Visits to a client's home, school or work as well as experiences in the community, such as supermarkets and on public transport, are foundational for occupational therapy. Given that, the cut to travel claims will also put additional pressure on Ms Senger's business. "Ultimately, occupational therapy is about life skills, so we practice those in our clinic but if we don't go into the environment, there's no way of knowing if those skills are transferring," Ms Senger said. "And for some of our families, they just can't come here — they're financially strapped or they're single parents with four children who all require care — so we go to them." Ms Senger is now considering introducing a gap fee to cover travel costs. "We wouldn't change anything in terms of the hourly rate," Ms Senger said. "For us, the gap fee would be the 50 per cent travel that the NDIS has taken away. "Anything more, we will do our hardest to avoid." It's a price Jon's mother, Megan, is not confident her family can afford to pay. "Or something else gets missed in order to pay for it — maybe that's takeaway one night or a night out at the movies. "I think it's really heartbreaking that you have to make those choices." 'It's a pretty big kick in the guts' Ms Senger and Ms Caldow are still considering workforce changes, but both have made the decision to let go of their therapy assistants, who are typically university students. "I was really hopeful this time around that with all the cost of living increases, wage increases, superannuation increases, the NDIA would see the numbers weren't adding up," Ms Senger said. "I can't believe that's not been recognised and instead we're being portrayed as money hungry, price-gouging, fraudulent allied health professionals because of a few bad eggs, which are in every profession. "All I want is to provide the best care for my kids and these new changes really stop us from being able to do that." In Australia, more than 65 per cent of NDIS participants have their funds managed by a financial intermediary or plan manager. Jess Harper, the chief executive of Disability Intermediaries Australia, said those working in that sector are also reeling. "It's a pretty big kick in the guts," he said. "And on top of that, the NDIA has also made the decision to pretty significantly cut the amount and the type of service plan managers can claim for." From July 1, a one-off establishment fee of $232 will be scrapped and some loading charges will also be removed, with a nationally consistent price introduced. "In the last 12 months, we've seen more than 600 providers close their doors because they just can't keep the lights on and we expect that number will be significantly more this year," Mr Harper said. "In the ACT, we've had 22 providers close their doors in the past 12 months, and we've had a further four give notice that they'll be closing come July 1. "Ultimately, what we're seeing is a race to the bottom on quality and so for participants, that means they're getting less — less choice, less access, less availability." Independent pricing 'makes a lot of sense' Mr Harper said introducing an independent pricing approach was vital. "The sector has been calling for this for years," he said. "It is beyond belief that a government agency that is ultimately the payer gets to set the prices." It's a view shared by Michael Perusco, the chief executive of National Disability Services, an organisation that advocates for disability service organisations. "Like aged care, like health, we think it makes a lot of sense for pricing in the NDIS to be independent," Mr Perusco said. He said he was "deeply concerned" that providers of therapy support were going to leave the market. "Organisations are looking at their finances and are going to make very difficult decisions about what they can continue and what they can't," Mr Perusco said. "For some of those organisations, it means they won't continue at all. "If that occurs, participants suffer and particularly those with the most complex needs who need the NDIS the most."