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The NDIS and Provider Pricing

The NDIS and Providers Pricing Lists -

This is a topic I hear talked about often. It doesn't matter whether you are NDIA Managed, Plan Managed or Self Managed, the participant experience with being charged for services ranges far and wide -The good, the bad and the ugly.

So where do these prices come from and why do they differ depending on where you go and who you see?

The NDIA sets and reviews regularly their Pricing arrangements and Price limit guide (formerly NDIS price guide). This guide tells registered NDIS providers the maximum amount that can be charged for their services.

This price can differ depending on what service is being delivered, where the service is delivered, whether the service was on a weekday or weekend, the qualifications of whom is delivering the services, and also the region in which you are receiving that service (remote allowance).

But some of these services are charging me $300 per hour! you say?

Yes, some of the higher risk services, which require a higher level of experience and/or qualifications are allowed to charge this much.

The NDIS pricing limits is established to support NDIS providers to provide quality and best practice guided services.

This hourly rate as set by the NDIA, is designed to support providers with operational costs such as business overheads, administration, training and upskilling staff, staff governing body registrations and insurances, and supervision where required.

The NDIS Pricing Arrangements and Price limit guide also allows providers to charge for additional time spent, that DIRECTLY relates the participants therapy/supports.

This includes

- Non Face to Face Support Provision

- Provider travel to and in some case from appointments

- Short Notice Cancellations

- NDIS Requested reports

What a provider CANNOT charge for is

- Time spent on administration, such as the processing of NDIS payment claims for all clients

- pre-engagement visits;

- developing and agreeing Service Agreements;

- entering or amending participant details into system;

- making participant service time changes;

- staff / participant travel monitoring and adjustment;

- ongoing NDIS plan monitoring;

- completing a quoting tool; and

- making service bookings and payment claims

- any activity that does not relate directly to the participants individual supports

All Registered NDIS providers are governed by this price guide and may not charge more then the price limits outlines, however depending on the service may choose to set their own price guide below this limit. This is the providers choice and may depend on their provision of services on offer, how many staff they have employed, how many locations they have etc.

It is important to note that registered NDIS providers also have certain requirements to meet as set by the NDIS quality and safeguarding commission, that allows them to maintain quality control and keep their registration, which also requires ongoing financial investment from providers.

However, Non Registered providers, accessed by both Plan or Self Managed participants, have a little more flexibility and may charge more or less then the recommended price limits.

These providers are likely to charge less due to the flexibility around governance of the NDIS (they are not audited or monitored for compliance, however do need to adhere to the NDIS Code of Conduct) and smaller business overheads. There are also many unregistered sole traders.

So how do you know when you are being charged the right amount?

1. If you are NDIA managed then you are able to access services from NDIS Registered Providers Only. These providers are governed and must charge no more then the NDIS Pricing Arrangements and Price Limits guide.

2. If you are Self or Plan Managed, you are able to access both Registered and Non Registered providers, giving you the flexibility of choice and control and finding a provider and service rates you are comfortable with.

It is important to note that not all NDIS plans are funded the same, and participants are able to negotiate their rates with their providers to ensure they are receiving the best value for money to reach their goals.

What to do if you think you have been charged incorrectly?

Firstly - speak to your provider, we are all human beings and sometimes small errors do occur, they can double check your invoice for you and correct if needed.

Secondly - review your current service agreement with your provider, was their pricing schedule outlined in the agreement? Is there any special conditions that may have been missed?

Thirdly - review the NDIS Pricing arrangement and Price Limits Guide to check the charges align with the service you have received?

Lastly - Contact your Support Coordinator or Local Disability Advocate to support you to correct the charge, make a complaint or seek an alternative provider.

More information about pricing can be found on the NDIS website

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