Understanding the price guide is one of the most important things you can do. It will help you to navigate the sophisticated maze of NDIS.
It is a big deal, NDIS Pricing Guide defines following key parameters:
- Price limits: Most supports the NDIS will fund have maximum prices setup by the NDIA. Good Plan Management provider can help you find local businesses that with much more competitive pricing and better service levels.
- Rules for claiming: There are a very small number of additional fees that some providers can add to their invoices or claims.
- Exceptions of supports: While the NDIS Commission formally has the responsibility of overseeing quality of NDIS supports, the Price Guide does not include some descriptions of what is expected of different supports.
- Speaking NDIS jargon: Learning to talk the NDIS professional jargon will be extremely beneficial during planning meetings. Using the right words will allow you to get the support you need in your plan.
- Improving Service Design: Knowing the different NDIS support types and prices in the catalogue, will help you to get paid for the services you need.
- Charging Smart: Knowing the right line items and prices will help you to navigate and evaluate quotes and proposals for services. It also helps you to choose alternative line items to be more effective.
- Hidden Flexibility: It is not an accident that line item descriptions are vague. The NDIA has left them open to interpretation, to maximise your control.
Fluent understanding of the NDIS Price Guide will improve your effectiveness in working with NDIS.
The Pricing Guide is not a Legislation
The NDIS Pricing Guide is not a legislation and a subject to change on a regular basis. The Pricing Guide is updated at least once a year and is purely at NDIA’s discretion to change. e.g. In 2020 the Pricing Guide got changed more than once.
You can always check the NDIS website for the latest version.
The idea of NDIS is to create services that are co-designed and driven by participants, not the funding body, due to this the Pricing Guide does not provide a lot of practice guidance.
Reasonable and Necessary and NDIS Eligibility Criteria are legislations and cannot be changed easily. However, you have a lot of room to move within the pricing guide if you are familiar with its structure.
NDIS sees itself as a funding body, their role is to fund and facilitate your choice. It is not an accident that line item descriptions are vague. The NDIA has left them open to interpretation, to maximise your control.
Some prices can vary depending on your location in Australia:
Queensland (QLD), New South Wales (NSW), Victoria (VIC) and Tasmania (TAS)
Western Australia (WA), South Australia (SA), Northern Territory (NT) and Australian Capital Territory (ACT)
Remote Areas (MMM 6)
The NDIS is using Modified Monash Model (MMM) to determine whether a location is a city, rural, remote or very remote. The scale is going from 1 to 7, where 6 is remote areas and 7 is a very remote area.
MMM 6 comes with +40% price loading.
Find what area your suburb in, through this spreadsheet and PDF.
Very Remote Areas (MMM 7)
MMM 7 comes with +50% price loading.
National Non Remote (MMM 1-5)
MMM 1-5 is classified as National Non Remote and uses the standard (lowest) NDIS price rate.
Sections of the Price Guide
The Price Guide is split into three sections and each section has its own rules of flexibility:
Flexible within the same category but not between categories:
- Improved Daily Living
- Improved Life Choices
- Improved Learning
- Improved Health and Wellbeing
- Improved Relationships
- Finding and Keeping a Job
- Increased Social and Community Participation
- Improved Living Arrangements
- Support Coordination
For example, if you saved up some money on Improved Learning, you would not be able to relocate them to Improved Relationships or any other category within core. The money can only be spent within the same category.
Not flexible at all. Can only be used to purchase specific Items as approved by NDIA and include following categories:
- Assistive Technology
- Home Modifications
For example, if your plan has allocation for speech generating devices, you would not be able to spend the money on lighting modifications at your home or something else within assistive technology. You will usually need that particular model quoted and approved again.
Totally Flexible, except for periodic payments and consists of following categories:
- Assistance with Daily Life
- Assistance with Social, Economic and Community Participation
For example, if you manage to save some money for cleaning in assistance with daily life, you can re-allocate money to transport or assistance with social and community participation.
Periodic Payments are a legacy from the Centrelink era (mobility allowance), where transport paid as a periodic payment. In this case it would be outside of your possible: plan managed, agency managed or self managed. The default option for transport is for cash to be transferred to your bank account every fortnight. So you don’t need to account for how you spend that money.
Providers travelling to deliver a support to you can charge:
- The cost of the worker's time at the relevant line item (up to 30 minutes in a metro area or 60 minutes in a regional area). Core support providers can only bill one way. Capacity Building providers can bill for both the trip there and back.
- $0.85 a kilometre for a vehicle that is not modified for accessibility (recommended price, can be higher or lower)
- Other forms of transport or associated costs up to the full amount, such as road tolls, parking, public transport fares.
- In remote and very remote areas, providers can enter into their own agreements with you to set reasonable prices for travel.
The Price Guide now differentiates between two types of transport:
- Activity Based Transport: Transport “to, or from, or as part of, a community participation support”. This transport must be delivered by a provider who will also be supporting you at the destination.
- General Transport Services: This category includes all other types of transport: transport to places where service is delivered by an unregistered provider, a provider other than the transport provider or somewhere where no support is being delivered.
|Activity Based Transport||General Transport Services|
|How can it be claimed?||
Can be claimed from the Activity Based Transport line item in
||Can only be claimed from the Transport support category in Core supports.|
|What is the price?||
Not price controlled, but the NDIA suggests the following prices:
It’s important to note that you need to consent to any transport charge, even if it meets the above guidelines.
|Not price controlled.|
|Who can deliver it?||Only registered providers. The transport provider must also support the person at their destination.||No restrictions - typically used to pay taxis or rideshare services.|
The Exception: Stated Supports
Stated Supports is the exception to the rules of core, capacity and capital described above. When funding is stated in your plan as Stated Support, it is not flexible at all. This means the only thing it can be spent on is the support described in the plan.
Support Coordination, Therapy and Nursing line items in Core
The current Price Guide includes duplicate line items for Support Coordination, therapy and nursing supports to give you greater flexibility in how you purchase these items. This means that (for now) you can use either their core or capacity building budgets to pay for Support Coordination or health-related therapy and nursing.
Temporary Transformation Payment (TTP)
You might notice that many core support line items have two variations - one with and one without "TTP" at the end.
Providers do not need to apply to charge the TTP prices - they are free to charge them so long as they comply with the following criteria:
- publish their service prices;
- list their business contact details in the Provider Finder and ensure those details are kept up-to-date
- participate annually in an Agency-approved market benchmarking survey.
Although the TTP allows providers to charge higher prices, the NDIA have not included extra money in new plans to accommodate this. Participants disadvantaged by TTP are encouraged to seek a plan review.
Short notice cancellations
Providers can charge up to 100% of the cost of a scheduled support when you make a short notice cancellation. Short notice is:
- less than 2 clear business days’ notice for a support that is less than 8 hours continuous duration and worth less than $1000; or
- less than 5 clear business days’ notice for any other support.
Non Face-to-Face time
This Price Guide includes a clarification on what type of non face-to-face supports providers can bill for, stating that providers are able to charge for support that meets the following criteria:
- the activities are part of delivering a specific disability support item to that participant (rather than a general activity such as enrolment, administration or staff rostering),
- the provider explains the activities to the participant, including why they represent the best use of the participant’s funds (i.e. explains the value of these activities to the participant),
- the proposed charges for the activities comply with the NDIS Price Guide, and
- the participant agrees to pay for the activities (preferably in a formal service agreement).
Shadow shifts may be considered where you have complex individual support needs, e.g. complex communication or behavioural challenges or medical needs.
Where the individual would require shadow shifts to assist with the introduction of new workers, and this is the desired method by you or your family, the provider may claim for up to 6 hours of weekday support per year.
This fee applies to all new NDIS participants in their first plan, where they receive at least 20 hours of personal care/community access support per month. This payment is to cover non-ongoing costs for providers establishing arrangements and assisting participants in implementing their plan.
The establishment fee is claimable by the provider who assists the participant with the implementation of their NDIS Plan, delivers a minimum of 20 hours per month of personal care/community access support and has made an agreement with the participant to supply these services.
The establishment fee will operate as follows:
- Providers can charge against a plan if assisting a new participant who is new to NDIS and new to the provider.
- A provider can charge when they are maintaining an existing client of theirs who is commencing as a participant of the NDIS.
- Should a participant wish to change providers on commencing their first NDIS plan, a price is set and available to the new provider. This is to assist the participant in changing provider.
- A budgeted amount is included in the first plan for NDIS participants, in case they need to this type of assistance from providers to design and implement support arrangements.
Secret Line Item: Self Management Capacity Building 01_134_0117_8_1
You have the option to use Core budget to pay for self management capacity building. Examples of the types of assistance you could purchase through self-management capacity building include:
- Developing administrative skills to manage budgets, records, and coordinate services
- Assistance to source or negotiate the purchase of supports
- Assistance to explore or find more options to achieve your goals
- Help to get you ready to directly employ support staff, such as recruitment, training, managing employment contracts, and your obligations as an employer
- Advice to support quality and safeguarding standards
- The purchase of a payroll service to pay support staff
- Assistance to build and develop community supports
The price is currently set at $63.23 per hour (but remember that price limits don't apply to self managers!)
Secret Line Item: Low Cost AT
You can use Core funding to purchase low cost capital items like large print calendars or special bath mats. Low cost assistive technology is defined as "generally under $1,500 per item". Please google “AT & Consumables Guide - NDIS”.
Maximising Your Flexibility
The NDIS have left line items open to interpretation on purpose.
Providers and you are encouraged to use a "best fit" approach when deciding which line item to charge for a given support. This leaves a lot of room to wiggle.
At first glance, it might appear that your plan does not have the funding you need for the type of support you want. Certainly this often the case - understanding the flexibility of the Price Guide will get you far but it can't solve all planning errors.
But sometimes there is funding available in other categories that might just do the trick.
BMX Track Example
Let’s say you are living next to an awesome BMX Track and would like to get to know guys and girls who go there regularly. Let’s have a look how you might be able to use your funding flexibly:
Core Supports. You can use the line item Assistance to access community-based social and recreational activities and hire a support worker to help you to learn and practice BMX cycling and establish relationships with people at the BMX track. If you require adaptation to your bike or additional equipment as a result of your disability, you can use some low cost assistive technology line item.
Support Coordination. People rarely have Support Coordination hours to spare, but if you do... You certainly can use these funds to receive support to “strengthen a participant’s ability to design and build their support” (remembering that friends are considered informal supports in NDIS terms): Coordination of Supports 07_002_0106_8_3.
Improved Social and Community Participation. Supporting you to create relationships with people at the BMX Track could easily be described as:
- 09_006_0106_6_3 Life Transition Planning Including Mentoring Peer-Support And Individual Skill Development: "Establishing volunteer assistance within the participant’s home or community. For instance… taking part in social activities and maintaining contact with others."
- Individual skills development 09_009_0117_6_3: If you wish to learn to ride BMX as a way to "develop skills for community, social and recreational participation" (Remember, this would only be considered reasonable and necessary if your disability presented additional challenges for learning to ride BMX like a mobility or communication related impairment). If it is done in a group environment, you can use Skills Development In A Group 09_007_0117_6_3.
Improved Relationships. You might use Improved Relationships funding to build the skills required to facilitate your integration in the BMX group. Line item Individual Social Skills Development 11_024_0117_7_3.
Improved Health & Wellbeing. You experienced a mobility impairment as a result of your disability, you might like to work with an Exercise Physiologist or Personal Trainer to learn to BMX safely. Following line items can be used:
- 12_028_0126_3_3 - Exercise Physiology In A Group - Group of 3
- 12_029_0126_3_3 - Personal Training
- 12_027_0126_3_3 - Exercise Physiology
Improved Daily Living.
- Individual Skill Development And Training Including Public Transport Training 15_037_0117_1_3: Individual training provided in the home for general life skills to increase independence. You might like to use this to improve your cycling safety or build skills for social interaction.
- Community Engagement Assistance 15_045_0128_1_3: This is a program to empower participants and improve interactions between participants and their social networks. Assistance to engage effectively in the community through a group approach to help achieve goals, gain insight into their lives and make informed decisions.