Latest NDIS update: New pricing arrangements (Price Guide).

The NDIS has made some changes to how it sets and refers to pricing arrangements. Pricing changes are usually made every year, with updates each quarter.

Updated pricing documents for 2021-2022 were released last week.

Today, we’re taking a look at the main changes and what they may mean for you.

In summary:

• NDIS Price Guide is now called NDIS Pricing Arrangements and Price Limits
• More detail on claiming supports for plan managed participants
• Clearer rules around charges for non-face-to-face supports
• Managing charges for more than one worker or therapist at a time
• Prepayment availability for some assistive technology supports.

NDIS Pricing Arrangements and Price Limits.

The NDIS has changed the name of the quarterly Price Guide to Pricing Arrangements and Price Limits. The purpose of the document remains the same.

It sets out the pricing arrangements and price limits that the NDIA has determined will apply to the provision of supports for participants in the NDIS. The intent of these documents is to assist participants and providers to understand the ways in which price controls work in the NDIS.

A new Pricing Arrangements and Price Limits document has been released, along with an updated support catalogue that lists the support items providers can use when logging a payment. We’ve summarised the main changes below.

For plan managed participants.

The NDIS has clarified information that plan managers must have in order to process a payment from your NDIS Plan.

• A valid tax invoice must be supplied, plus relevant information about the goods or services purchased
• The provider’s Australian Business Number (ABN) must be included (usually on a tax invoice). Exempt providers must meet relevant ATO requirements and conditions and be able to provide evidence to the Plan Manager.
• The price must not exceed the price limits regardless of whether it has been purchased from a registered or unregistered provider.
• A plan manager should not process a claim for supports or services which are not reasonable and necessary and meeting a disability related need..

The plan manager must also ensure the claim complies with the NDIS Pricing Arrangements and Price Limits.

Charges for non-face-to-face supports.

Providers can claim for expenses relating to supports in addition to the support itself if the following conditions are met.

• NDIS Pricing Arrangements and Price Limits must indicate non-face-to-face supports are claimable for that item
• The charges comply with the rules
• The activity is part of delivering a specific disability support item
• The provider explains the activity and why it represents the best use of your NDIS funds
• You have agreed to the expense in advance (it is included in the service agreement).

Providers cannot charge your NDIS Plan separately for:

• Pre-engagement visits
• Developing service agreements
• Administration such as entering details, quoting or changing service times
• Ongoing NDIS Plan monitoring
• Making service bookings and payment claims.

Claiming for more than one worker or therapist.

There may be times when you need assistance from more than one therapist or support worker at the same time. When this happens, providers can claim for everyone’s time. The NDIS has made some changes to accommodate this situation.

“Shadow shifts” will allow for new workers to safely learn how to support participants with complex individual support needs.

The NDIS will also cover supervision of or training for therapy assistants by the supervising therapist as part of a handover or a case conference between therapists about your specific support needs.

Prepayments.

Prepayments occur when funds are paid in advance of the support being provided. Generally, the NDIS will only pay for supports after they have been delivered, except for higher cost supports that may be paid in stages.

Providers will sometimes require prepayment or partial prepayment to cover expenses to build or tailor supports to your needs. They can now claim prepayments for some supports without written approval from the NDIA, providing the following conditions are met.

• The support item is an assistive technology, vehicle modification, or home modification
• The item exceeds $1,500 or is custom made for you and a valid quote has been accepted by the participant
• A service agreement outlines the requirement of a prepayment
• The final payment of no less than 10% of the total cost may not be claimed until you have received the support ready for use.

Other changes.
Price limits for supports delivered by disability support workers have been updated to allow for the increase in the super guarantee from 9.5% to 10% and an increase in the minimum wage
Price limits and refurbishment thresholds for specialist disability accommodation (SDA) have been increased by 1.1%
Transitional pricing arrangements for group-based supports have been extended until 30 June 2022.
Information sourced from the National Disability Insurance Scheme Pricing Arrangement and Price Limits 2021-2022 Version 1.0 © National Disability Insurance Scheme Launch Transition Agency 2021

Got questions? Leap in! can help.

If you have any questions about how these changes may affect you or your NDIS Plan, get in touch with the Leap in! Crew. Call 1300 05 78 78, email crew@leapin.com.au or chat with us online.

Further reading

NDIS update: Highlights from the latest NDIS Quarterly Report.

The NDIS and employment: Creating new opportunities.

What the 2021 Federal Budget means for people with disability.